State Laws and Insurance Coverage for Male Infertility

Objective

To assess coverage of male infertility in state laws. Infertility is experienced by 12% of couples, unfortunately, however, infertility treatments are expensive and infrequently covered by insurance. Furthermore, many states lack explicit laws on fertility coverage.

Methods

The National Conference of State Legislatures and individual state legislature websites were used to assess fertility coverage. These were queried for health insurance mandates or fertility coverage by evaluating healthcare-related legislation.

Results

Less than half (21/50) of states require coverage. Among these, there is substantial variability in how infertility is defined. A minority (5/21) use the definition of 6 or 12 months of unprotected intercourse in those over or under age 35, respectively, without conception. Others have no length of time stated (7/21) or it ranges from 1 to 5 years (9/21). Some states restrict coverage to specific groups, such as NJ (coverage if under 46 years old). While 19 states include female infertility coverage, only 13 include coverage for males. Lastly, only 6 states include explicit legislation and criteria for treatment of male infertility not related to iatrogenic causes.

Conclusion

Male infertility coverage is lacking across the United States. Male exclusion places greater burden on females, which may lead to missed opportunities to diagnose medical conditions, and miss reversible causes of infertility. Despite recommendations that both partners undergo infertility evaluations, only 6 states have legislation for insurance coverage of non-iatrogenic infertility. Practitioners must be well-acquainted with laws and stay up-to-date in the ever-changing legislative landscape of infertility care.