Illinois and its Health Insurance Coverage for Infertility Treatments

By Gina McCammon

Many people ask themselves, “Do I want children?” And this can lead to a series of related questions like, “How many kids do I want?” “How old do I want to be when I start my family?” “Should I be a parent?” For some, biology is on their side, and they don’t have to worry about fertility. Others must grapple with infertility and confront the possibility that even if they answer “yes” to wanting children, it might not happen, at least not without assistance. With today’s medicinal technology, people who face infertility can look to treatments like fertility drugs, intrauterine insemination (IUI), in-vitro fertilization (IVF), and cryopreservation. However, these procedures can come with a high cost. Now the question is not just how much does raising a child cost, but how much will getting pregnant cost? Depending on the state, health insurance can help cover the cost of such treatments. In Illinois, where does health care coverage stand with reproductive health treatments like IUI and IVF?

Ten to fifteen percent of heterosexual couples are diagnosed with infertility following one year of unsuccessfully trying to conceive. If a couple seeks treatment, they undergo testing to determine the source of the problem (refer to Figure 1). Treatment revolves around the source, if the medical professional can detect one. Options usually include cycles of IUI or IVF. IUI is the placement of specially prepared sperm directly in the uterus. IVF is a more complicated set of procedures that places specially prepared embryos in the uterus. Within those treatments is a lengthy list of steps and requirements to receive the actual service like: pre-IVF screening, physician consultations, egg retrieval procedures, fertilization, etc. They are separated by the chosen clinic into Included Services and Excluded Services, meaning the prices depend on the clinic and the presented prices do not allocate a total cost because unaccounted charges like unexpected appointments and tests are omitted. On top of that, a majority of patients require more than one cycle of treatment according to National Library of Medicine.

Figure 1 sourced from: KFF

For one complete cycle of IVF, it can cost anywhere between $10,000 to $15,000, averaging about $12,000. Again, this does not include the Excluded Services and varies on the clinic and jurisdiction. Thus, patients bear the burden of researching clinics that fit their needs and their wallet. But as noted on the Advanced Fertility Center of Chicago website: “Do not equate cost with quality . . .” A clinic may cost less and their success rate may be lower, but that does not necessarily mean that a clinic that costs more has a higher success rate. Infertility treatments are an investment of time and money, and it’s best to make an informed, educated investment.

Twenty-one states have some infertility insurance coverage laws (see Figure 2); Illinois is one of them. Under Illinois’s plan, group health policies that cover more than twenty-five employees and offer pregnancy-related benefits must provide infertility treatment. Specifications include that the covered individual has been unable to get or stay pregnant, or has not had a successful pregnancy by assistance of less costly infertility treatments covered by the health insurance plan. The covered individual has yet to have four completed egg retrieval procedures and, if they have had a live birth from an egg retrieval procedure, they then have two more egg retrieval procedures available under the coverage. All procedures must be performed at medical centers that follow either the American College of Obstetric and Gynecology or the American Fertility Society vitro fertilization standards.

The Illinois state law for infertility insurance is comparatively progressive and works to ensure that persons diagnosed with infertility are not left to pay completely out of pocket. However, the costs of IVF and IUI extend beyond the coverage available with the Excluded Services, the varying prices of the clinics, the normal need of multiple completed cycles of treatment, and the fact that not every person qualifies for coverage.

Figure 2 sourced from: Resolve

The Access to Infertility Treatment and Care Act addresses this problem for all states. The federal legislation works to enforce group health care plans or health insurance issuers who offer group insurance to follow Illinois’s approach to support infertility treatments. What the proposed Act asks of Congress is to acknowledge that infertility is a medical disease recognized by the World Health Organization, the American Society for Reproductive Medicine, and the American Medical Association. Infertility affects a large number of American citizens. The Act also emphasizes how infertility deserves health insurance coverage because it compares to other serious diseases and conditions covered by health insurance. As the legislation states, “The ability to have a family should not be denied to anyone on account of a lack of insurance coverage for medically necessary treatment.”

Impressively, Illinois has infertility coverage that outshines most of the states. If the Access to Infertility Treatment and Care Act is enacted by Congress (and signed into law by the President), Illinois residents will see an increase in coverage for infertility treatments because the law will extend beyond group health insurance policies with at least twenty-five persons. The bill’s passage would cause an inevitable increase in utilization of IUI and IVF treatments and other infertility treatments because they would become more accessible and affordable to a wider population.

The next possible step to increase access to infertility treatment would be to incorporate infertility coverage into Medicaid. Medicaid reaches a wider number of U.S. citizens and would help lower income individuals access infertility treatments. As of 2024, no state Medicaid program covers IUI or IVF. New York has some coverage for diagnostic services and treatment, while eight other states provide diagnostic services, but no state provides comprehensive treatment according to KFF.

The Access to Infertility Treatment and Care Act prevents drastic variation from state to state and, if it is enacted by Congress, offers the possibility of greater access to infertility treatments and a possible expansion of Medicaid coverage. Increasing accessibility means more people can exercise their right to explore the question of “Do I want children?” knowing that resources are available to them, supported by their health insurance, and with less financial burdens.