Planning, growing, and raising families can be rife with challenges, and more and more people are seeking help with the process. 15% of couples are unable to get pregnant naturally after a year of trying, and 33% of Americans have used fertility treatments or know someone who has. The demand for assisted reproductive technologies (ART) is also steadily increasing at an estimated rate of 5-10% per year. As the rate of fertility treatments rises, so does the need for comprehensive, whole-person support from their insurers and their employers.
Payers need to adapt the way they support their members through the family-building journey to meet their changing needs. But what does this new fertility landscape look like? Here are the top four fertility benefits trends that payers need to be aware of in 2022 and beyond.
1. Offering fertility coverage isn’t enough–members also need additional support
Trying to conceive can affect all aspects of a member’s life, especially their mental health. Fertility treatments like IVF can be a long, arduous journey, negatively impacting stress levels, self-esteem, and mental health:
- Over half of adults struggling with infertility report symptoms of depression
- 46% have anxiety
- 25% say they have increased tension with their partner
- Some experience PTSD symptoms
“A fertility journey is a journey through a really thorny path,” says Dr. Brian Levine, Reproductive Endocrinologist and CCRM-NY Founding Partner and Practice Director. “When you go down this road, there are lots of bumps along the way and parents need support as they navigate the process.”
Payers are recognizing the need to provide comprehensive care for all aspects of the family-building journey, not just the fertility treatments themselves. Offering virtual or in-person access to mental health providers can be a lifeline for members, easing the symptoms of depression, anxiety, and stress that often plague the fertility process. Coverage can also go beyond mental health treatment, encompassing acupuncturists, nutritionists, and more at little to no cost to the member.
2. Recognizing LGBTQ+ members’ unique fertility needs–including infertility support
Historically, health plans and employers offered fertility coverage to members who met the medical criteria of infertility. This coverage incidentally excluded many, especially same-sex and transgendered couples and single parents by choice. While there has been a major shift towards removing barriers to access in fertility care, LGBTQIA+ members are still facing hurdles when building families.
“We have a large subset of the American workforce who is under-recognized in fertility, and resources tend to be more limited and more expensive,” says Dr. Levine. “A single mother or same-sex female couple is required to purchase sperm when there are less than 2,000 viable donors in the U.S. A single father or same-sex male couple require eggs and a uterus, and there’s close to an 18-month waiting list for a surrogate right now.”
Beyond “social infertility,” which stems in part from the societal issues above, some in the LGBTQIA+ community also suffer from physical infertility. While there are few studies investigating the rate of infertility in these communities, it’s estimated that 9% of men and 11% of women of reproductive age in the U.S. have experienced fertility problems. Infertility statistics also often don’t take into account transgender people who face an increased risk of infertilty due to gender-affirming hormone supplements.
“Simply put, payers are behind in treating LGBTQIA+ infertility and underserving a significant portion of the American workforce,” says Dr. Levine. Looking to 2022 and beyond, payers should continue to expand their understanding of the family-building needs of all communities and offer the medical and financial support each member requires to successfully plan, grow, and raise their families.
3. Leaning into transparency in fertility benefits utilization
It’s well known that fertility treatments can be expensive, with a single cycle of IVF costing between $12,000 to $17,000. However, members often struggle to ascertain what treatments are actually covered by their health plans and what they’ll have to pay for out of pocket. They may see a lifetime maximum benefit for fertility between $10,000 and $25,000, but not be aware that it can be easily reached during a single cycle of IVF. They may also learn that some tests in the IVF process are covered, while others are not.
“A massive trend we’re seeing from patients is a demand for transparency from payers when it comes to fertility treatments,” says Dr. Levine. Payers are becoming more transparent around the coverage and costs of fertility treatment, but they must continue to do so in the years to come. Bundling costs, using care advocates and digital front doors to simplify the patient navigation experience, and enabling accurate calculations of out-of-pocket costs can all help to drive additional transparency for members on their family-building journey.
4. Incentivizing good care and disincentivizing surgery
Over the past few years, the industry has reexamined how to improve outcomes during a treatment-assisted family-building journey. Payers are starting to incentivize care that gives people babies, not just pregnancies. In the past, IUI/IVF treatments often involved transferring two or three embryos, in hope that one would implant and result in a baby. These treatments increase the chances of pregnancies with twins or triplets, increasing the risk for the mother and baby, and the likelihood of miscarriage, preeclampsia, C-sections, and premature birth. “A single embryo transfer is now the recommendation from the American Society for Reproductive Medicine for the majority of people,” reports Dr. Levine. “Our goal is now to give people one single healthy baby at a time, and payers are now incentivizing these outcomes and the standard therapies that support them, including single embryo transfers.”
Along with incentivizing good care, payers are also shifting away from prioritizing surgery over fertility treatments. Surgeries for endometriosis or cyst removal often came before egg retrieval, which reduced the likelihood of getting high-quality eggs for fertility treatments. Now, patients are being treated in a step-by-step approach to ensure the best outcomes from the fertility treatment, by first removing the eggs and then taking the steps needed (whether surgery or a non-invasive treatment) to ensure a healthy uterus and successful implant. This shift is not only improving outcomes for members but also reducing the costs and complications that accompany surgery.
Improving fertility outcomes with Maven Clinic
As payers navigate the changing fertility landscape and the unique needs of their members, Maven is a partner in driving improved fertility outcomes. As the world’s largest digital family health solution, our comprehensive fertility and maternity program includes ongoing assessments, proactive check-ins, and human touchpoints, giving members the wraparound care they deserve during and after their family-building journey.
Schedule a call today to see how Maven can support your members, lower costs, and improve fertility outcomes.
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