Preconceived Notions: Cancer, Fertility Coverage and the Law
A CANCER DIAGNOSIS may spur a person to think first about mortality, and only later to consider maintaining their fertility. But anyone with cancer who wants to have children now or in the future should raise the subject with an oncologist, because side effects of some cancer treatments and medical procedures could cause infertility. It is a good idea for a person with cancer to ask their oncologist whether their cancer treatment will cause infertility, and whether it is a good idea to preserve fertility prior to beginning treatment. For people who want to have children, it’s important to know whether your health insurance covers fertility preservation and infertility treatment and, if so, how to optimize that coverage.
Federal law does not require health insurance companies to cover treatments related to fertility. The Patient Protection and Affordable Care Act (ACA), a federal law passed in 2010 and implemented in 2014, does not mandate coverage of fertility preservation and infertility treatment. That’s because the ACA, often referred to as “Obamacare,” does not consider this type of health care to be one of the essential health benefits for which coverage is mandated. But the ACA instituted changes to previous law that can help people who need these treatments.
The ACA prevents insurers from setting higher insurance rates for women and also blocks insurance companies from discriminating against people with preexisting conditions. Before the ACA, women had been denied insurance coverage for infertility treatment because their condition was considered to be a preexisting condition. In addition, the ACA eliminated lifetime caps on insurance coverage. This is critical for people facing infertility because of the extremely high costs associated with treatment.
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