When Katherine* accepted a job offer a few years ago, health insurance barely crossed her mind.
She knew her employer, a major media company, offered benefits, and that was enough for her. After all, she was healthy and in her mid-20s, and couldn’t remember the last time she had been to the doctor. Perks like a free gym membership and parking pass were more interesting at the time.
But now, as she contemplates a career change, health insurance isn’t just a factor—in many ways, it’s the only factor.
“Do I love my job? No. I truly can’t see myself doing it for another five years, especially with kids,” she says. “But can I afford to leave it? Probably not.”
Katherine’s company, it turns out, offers very good insurance. So good that it covered three rounds of expensive IVF treatments, allowing her to conceive and give birth to her son with almost no out-of-pocket costs.
“We couldn’t have afforded to do this otherwise,” says Katherine, whose husband’s company doesn’t cover fertility benefits through their health plan. “We’re lucky—we’re so, so lucky. But if we want more children, and we do, I can’t realistically change jobs.”
The Cost of a Family
While the costs of IVF range, they’re above $20,000 per cycle in most major American cities, according to a recent analysis by FertilityIQ.
FertilityIQ reviews fertility clinics and doctors, acting as a sort of information clearinghouse for treatments and trends. According to their annual employer survey, Katherine’s company is in the minority. Although the number of U.S. companies offering IVF benefits grew 10 percent in 2017, 64 percent of employees receive zero coverage for the procedure.
For most people, however, fertility benefits are much more difficult to come by.
Pay to Play: When Insurance Determines Treatment
“Fertility treatment should be open to everybody, not just those with the right insurance—this is something I’m passionate about,” says fertility specialist Dr. Joshua Hurwitz. “Why do insurance companies decide who gets treatment and who doesn’t? Why does the nonmedical part of the medical establishment have a say in this?”
Dr. Hurwitz is on the front lines of the controversial and often convoluted world of fertility benefits. In 2017, he was among a team of doctors who worked with patient Melissa Thompson to improve fertility treatment options for cancer patients in Connecticut. Now known as Melissa’s Law, the legislation removes red tape that insurance companies once used to deny cancer patients access to preservation techniques such as egg freezing.
Hurwitz serves as a partner at Reproductive Medicine Associates of Connecticut (RMACT). Like many fertility clinics, RMACT has advisors on staff to help patients understand insurance coverage, and who will advocate on their behalf. Low-interest payment plans are available for those who are unable to afford out-of-pocket expenses.
Still, the reality is that not everyone is able to access the level of care recommended by doctors.
“One of the saddest things is when we say to a patient, ‘this is the best treatment for you,’ but they can’t pay for that treatment,” says Dr. Joshua Hurwitz. “It’s heartbreaking.”
When IVF Isn’t an Option
Like many patients, Owaine didn’t fully understand fertility benefits at the beginning of the process.
Owaine—who uses male pronouns—used fertility treatments to conceive both of his children. His partner’s employer offered some coverage, but as they quickly discovered, it wasn’t as comprehensive as they originally thought.
“We thought we had 50 percent coverage, but it was more complicated than that when we got into the nitty-gritty,” he says. “Not all treatments were covered, and the plan was extremely cookie-cutter. When you think about how different people’s bodies are, it seems strange to have this one-size-fits-all approach to fertility.”
Fertility coverage is notoriously spotty. Some plans cover consultations but not treatment, some cover intrauterine insemination (IUI) but not IVF, others will cover oral medications but not injectable fertility drugs. Some states have laws requiring certain coverage, but they vary widely.
Owaine’s plan, like many, did not cover IVF. With the procedure off the table, Owaine and his partner decided to conceive using IUI instead. While ultimately successful, the procedure took five tries with their first son.
Frustrated by the disconnect between his own doctors’ recommendations and treatment prescribed by his insurance company, Owaine hired a private midwife to assist with home IUIs when conceiving his second son.
“The fact that only some services were covered put a big hole in our plans,” says Owaine. “But we were lucky—we had the funds to do it independently. We’re lucky to have the treatments we did and the births that we had.”
The Future of Fertility Benefits
“Lucky” is a word that comes up a lot when talking about fertility. Regardless of the number of procedures, financial hardship or other sacrifices, when the result is a baby, few question their decision.
“This is one of the very few things in life where the journey doesn’t matter, just the destination,” says Dr. Hurwitz. “But our patients deserve more.”
There are signs, however, that fertility coverage will improve.
In addition to tech giants like Facebook, FertilityIQ’s survey found that Silicon Valley peers including Pinterest, Uber, and Foursquare were upping their fertility benefits in a bid to remain competitive. While not close to comprehensive, Starbucks’ benefit is impressive in its inclusivity—85 percent of the company’s in-store baristas are eligible to receive $15,000 towards IVF treatment.
As for Katherine, she’s not optimistic that things will change soon enough for her family. After months of researching benefits packages, she’s prepared to remain at her job.
“I want another baby more than I want a better job,” she says. “I wish it wasn’t one or the other—I wish it didn’t take my year’s salary to get pregnant. But I try to focus on the positive: we have the chance to have another baby, and not everyone can say that.”
*Some names have been changed to protect the privacy of certain individuals.