OK, American ladies, do you understand this thing?
I've found some of the government websites to be surprisingly helpful. Still, there are features that I don't quite understand. Mainly this:
Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.I'm wondering, of course, how these changes will affect coverage for infertility. Will anyone now be able to buy a policy that covers IVF???
Right now, since I work for a small company that doesn't provide health insurance, I buy my own. It's a super-high-deductible plan—basically useful only if I get hit by a bus. I'm lucky to have even this plan. I committed the sin of moving to this state with a "pre-existing condition" of infertility, then was denied insurance here. I knew I couldn't expect any IF coverage, of course, but was denied any coverage at all, solely because of this diagnosis. (Otherwise, I'm in perfect health.) Because my state requires it, though, there were three or four special policies available for special "high risk" (WTF?) people like me. This was the only one that was remotely affordable.
Still, if I could get coverage for IVF, I would happily pay higher premiums. Could it be true that the new law will make this option possible?
And if it does ... is that good news for me or not? Because these changes aren't effective until January, and every month that I wait lowers my odds. What could be more ironic than receiving coverage just exactly when it's too late to do me any good?
Goddamn. I think it does mean that. And would be too little too late for me, too. Gah!
ReplyDeleteI hear ya!
DeleteWhile the most accurate answer is still very much, "Who knows?" I wouldn't start holding your breath.
ReplyDeleteThe PPACA is totally mute on the topic of infertility, and it appears it will still remain up to individual states to decide whether or not coverage for the diagnosis and treatment of infertility is covered as an "essential health benefit" (EHB). It is pretty clear that IF coverage is NOT considered an EHB at the federal level, so we'll continue on with the existing state-by-state basis that we have now.
What is frightening is that some states that do have some form of IF mandate already could take this opportunity to actually roll back their commitment to providing IF benefits. If these states adopt an EHB plan that does not include infertility coverage or if they opt to go with the default EHB plan, infertility benefits will be absent. Fertilitywithinreach has actually reviewed this aspect of the act here: http://www.fertilitywithinreach.org/blog/essential-health-benefit-plans-and-infertility-state-mandates/
On the other hand, the situation to which you are currently subjected will be reversed. Insurers will not be able to disqualify you for coverage solely based on your pre-existing IF diagnosis. So, you should be able to get insurance (in fact, you *have* to purchase insurance or risk a tax), but depending on what your state defines as an "essential health benefit," you likely won't get IF coverage.
How few employees does your company have an how many hours do you work? If the company has over 50 employees and you work more than 30 hours a week, then they also MUST provide you with insurance at an "affordable" rate, or the company will face a federal fine. Unfortunately, just yesterday it was reported that this part of the act has been delayed until 2015. The individual mandate still begins in 2014, though.
Hope that helps!
VERY helpful -- thanks! Not as fun as my brief fantasy of IVF coverage for all, but it's good to be informed.
DeleteMy company is well under 50 employees, so they still won't offer insurance. It's occurred to me to change employers, of course, but I HATE the idea of making career decisions based solely on factors so unrelated to my career! Plus, changing jobs would be super disruptive and stressful during TTC ... not to mention the ethics of the whole thing. (Nice to meet you! I'll take my IF benefits and maternity leave now!)
It sounds like these changes will definitely have both pros and cons. The possibilities of rolled-back mandates are scary. Your state has some form of mandated coverage, right? I hope you're able to keep -- if not expand on -- whatever coverage you have now!