New Health Insurance Benefit at UM Led to Increased Rates of IVF

Coverage led to a nine-fold increase in the rate of IVF for lower-salaried women.

11:15 AM

Author | Kelly Malcom

Baby Feet

For couples wanting to have a baby, a diagnosis of infertility can be devastating. And while infertility treatments, such as in vitro fertilization (IVF), offer hope for would-be parents, the procedure comes with a high price tag. On average, one cycle of IVF costs more than $12,000, and is typically not covered by health insurance.

In fact, according to the Society for Human Resources Management, in 2018 just one-quarter of employers offered health benefit coverage for IVF. In 2015, the University of Michigan joined this select group, adding coverage for infertility treatments, including IVF, to its self-managed health insurance plans.

"We try to be responsive regarding benefits that are important to our employees," says Marsha Manning, manager of medical benefits and strategy for the University of Michigan. "The discussion about IVF stemmed from a grassroots advocacy campaign and went through a decision process that included benchmarking, input from our medical carrier and input from our medical and policy experts."

The shift provided a unique opportunity for an interdisciplinary group of U-M researchers interested in reproductive access and equity. In a new research letter appearing in JAMA detailing a first-of-its-kind study, the team compared the use of IVF among university employees before and after the addition of the insurance coverage benefit.

Using insurance claims data for more than 18,000 university employees, "We identified women who used IVF before and after the new policy started in 2015," says James Dupree, M.D., M.P.H., associate professor of urology at Michigan Medicine, "and since IVF was not a covered benefit before 2015, we relied on certain patterns of ultrasounds and medications that were covered benefits and were specific to IVF to identify use of IVF."

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily updates on iTunesGoogle Play and Stitcher.

Using their algorithm, the group found an almost three-fold increase in the use of IVF following the institution of the benefit. What's more, the use of IVF increased more than nine times among women in the university's lowest-salary bracket. "U-M's coverage of in-vitro fertilization was associated with a dramatic increase in the share of women undergoing this expensive procedure," said Zach Levinson, a Ph.D. candidate in economics and health services organization and policy who led the data analysis.

Before the benefit went into effect, 65% of women getting IVF were in the highest income bracket with just 6% from the low income group. "After the policy, the salary distribution of women getting IVF was much closer to the salary distribution of the employee population, which from an equity standpoint is striking," says Dupree, who was also the lead author for the study.

While the team did note an across-the-board increase, they noted that IVF rates continued to be highest among women in the highest-income bracket. One explanation, they hypothesize, is that the 20% coinsurance, which can run $2000-3000, might still be too much for some people to afford.

Still, the benefit made all the difference for one U-M employee. "U-M is one of the few companies that I know to provide 80/20 coverage for assisted reproductive technology. IVF would not have been possible for my husband and I without this benefit," says the employee, who wants to remain anonymous.

"Knowing that even part of our care was covered provided comfort in otherwise uncertain times. One in 8 couples experience infertility, and I hope U-M can serve as a model for other companies to recognize this struggle and encourage financial support for employees simply trying to build their families."

MORE FROM THE LAB: Subscribe to our weekly newsletter

The study was funded by U-M's MCubed program and included researchers Richard Hirth, Ph.D., professor of Health Management and Policy at the U-M School of Public Health, who was the senior author for the study; Vanessa Dalton, M.D., M.P.H., professor of Obstetrics and Gynecology at U-M School of Medicine; Angela Kelley, M.D., of the U-M Center for Reproductive Medicine, now at Aspire Fertility; Helen Levy, Ph.D., research professor at the Institute for Social Research, Department of Health Management and Policy, School of Public Health and Gerald R. Ford School of Public Policy. Michael Lanham, M.D., Associate Chief Medical Information Officer, clinical assistant professor of Learning Health Sciences and assistant professor of Obstetrics & Gynecology; and Edward Norton, Ph.D., professor of Health Management and Policy and Economics at the U-M LSA also contributed to the work.

Paper cited: "Provision of Insurance Coverage for IVF by a Large Employer and Changes in IVF Rates Among Health Plan Enrollees," JAMA. DOI: 10.1001/jama.2019.16055

More Articles About: Rounds Von Voigtlander Women's Hospital Health Care Delivery, Policy and Economics Infertility Gynecology Urology All Research Topics Health Care Quality Hospitals & Centers
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories purple cells floating up close
Health Lab
Study links gene network and pancreatic beta cell defects to type 2 diabetes
Teams from Vanderbilt University Medical Center and the University of Michigan design a comprehensive study that integrates multiple analytic approaches that has linked a regulatory gene network and functional defects in insulin-producing pancreatic beta cells to type 2 diabetes.
smart watch on wrist
Health Lab
Clinical smart watch finds success at identifying atrial fibrillation
A Michigan Medicine research team developed a prescription wristwatch that continuously monitors the wearer’s heart rhythm and uses a unique algorithm to detect atrial fibrillation. The clinical-grade device, called the Verily Study Watch, proved very accurate at identifying atrial fibrillation in participants.
sketched out bacteria in a dish yellow and blue colors of U-M
Health Lab
This gross mixture has big benefits for the study of bacteria
Michigan Medicine researchers have found that growing bacteria on agar mixed with organs is an efficient and effective way to study infectious pathogens.
three pharmacists smiling
Health Lab
An innovative pharmacy service for pain management
An innovative service at Michigan Medicine offers pain management support for patients and care teams
patient giving paperwork and person saying no with hand graphic moving teal white grey navy orange
Health Lab
Why new patient paperwork isn’t just busy work
While it’s easy to overlook doctor's office questionnaires, that paperwork actually serves a vital role in better understanding how to treat you. Called patient reported outcomes, this information gives medical specialists insight into how treatments truly impact you as a patient.
green blue map of michigan
Health Lab
How does exposure to ‘forever chemicals’ impact your cancer risk
Pearce, professor of epidemiology at the School of Public Health and co-lead of Rogel’s cancer control and population sciences program, reflects on the project and why bringing this study to Michigan is so critical.