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The Massachusetts Infertility Insurance Mandate: not nearly enough
Katherine G Koniares1, Alan S Penzias2,3,4, James Roosevelt5,6
1Department of Obstetrics and Gynecology, UConn School of Medicine, Farmington, Connecticut.
Many women in Massachusetts cannot access infertility insurance due to numerous state and federal exemptions. Expanding the Affordable Care Act’s Essential Health Benefits to include infertility care is recommended.
Area of Science:
- Health Policy
- Reproductive Health
- Insurance Law
Background:
- State laws mandate insurance coverage for infertility diagnosis and treatment.
- Statutory exemptions can limit the scope and impact of such mandates.
- Understanding these exemptions is crucial for assessing access to fertility care.
Purpose of the Study:
- To evaluate the effect of federal and state statutory exemptions on the Massachusetts Infertility Insurance Mandate.
- To determine the proportion of reproductive-age women eligible for infertility insurance benefits.
Main Methods:
- Population-based cross-sectional study using deidentified, public data from 2016-2019.
- Analysis of reproductive-age women (20-44 years) residing in Massachusetts.
- Identification of state and federal statutory exemptions in relevant laws and codes.
Main Results:
- Public health plans (Medicare, MassHealth, TRICARE, FEHBP) are exempt due to federal/state statutes.
- Self-insured employer plans are exempt under ERISA.
- Only 26.2%-36.0% of reproductive-age women were eligible for benefits between 2016-2019.
Conclusions:
- Statutory exemptions significantly reduce the number of women eligible for infertility insurance.
- The Massachusetts Infertility Insurance Mandate's reach is limited by these exemptions.
- Expansion of the Affordable Care Act's Essential Health Benefits to include infertility care is proposed.
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