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Maryland Insurance Mandate Expands to Cover Donor Sperm

In 2015, the Maryland legislature updated the Maryland Insurance Mandate to allow same-sex couples to use donor sperm, creating an inequality for heterosexual couples needing donor sperm to conceive. However, patients and leaders in the infertility community have advocated to broaden the coverage and, as of earlier this year, the Maryland Insurance Mandate has been expanded to heterosexual couples who need donor sperm to have a child.

Stephanie Beall, M.D., Ph.D., who sees patients in our Columbia and Towson, MD, offices, provided valuable testimony to the Maryland Senate and House of Delegates in January 2016. She spoke on behalf of the Shady Grove Fertility patients who would benefit from and would need assistance of donor sperm to have a baby. Fortunately, her testimony, as along with the fervent advocacy work of organizations like Shady Grove Fertility partner RESOLVE, the National Infertility Association, made a difference.

The Fertility Parity Bill was signed by Maryland Governor Larry Hogan on May 10, 2016.

“It was an honor to work with Senator Kagan and Delegate Hill and give testimony on behalf of the many couples who need to use donor sperm to have a baby in the state of Maryland. By expanding the Maryland Insurance Mandate for fertility coverage, this will create an opportunity for many couples who would otherwise not be able to afford the care they need to have a child.  Now we can help them make their dreams come true,” explains Stephanie Beall, M.D., Ph.D.

Why People Need Donor Sperm

Donor sperm is widely used for same-sex female couples, single women, and couples diagnosed with severe male factor infertility. Of the one in eight couples who experience infertility, up to 10 percent of the patients with male factor infertility may be candidates for using donor sperm.

For men with male factor infertility, there are a number of contributing factors that result in low quantity or poor quality sperm. Some men are simply born without the cells in the testicle that are needed for sperm manufacturing; while others have genetic problems that leave them with no sperm or very little sperm. Of men who do have sperm, there are cases when the sperm may not fertilize or promote good embryo development. In addition, men with cancer who have received chemotherapy often lose the ability to make sperm.

 Why This Change to the Maryland Insurance Mandate is Important

This amendment to the existing Maryland Insurance Mandate creates access to fertility coverage for more patients. An estimated 120,000 couples who live in Maryland will experience infertility—and roughly half of those couples will have male factor infertility. The change to provide coverage for donor sperm enables families who would otherwise be ineligible to use the Maryland Insurance Mandate. Their struggle due to financial barriers may be over.

Maryland is one of just 15 states that have an infertility insurance mandate that requires health insurance plans to offer or provide coverage for in vitro fertilization (IVF) procedures. While this benefit is advantageous to patients who are employed through the state of Maryland, there are some limitations. For example, employers with 50 or fewer employees, or religious organizations whose beliefs conflict with fertility treatment, are exempt from offering this coverage.

The Benefit for Patients

According to Shady Grove Fertility’s Donor Program Director, Michele Purcell, M.H.A., R.N., “This is a huge step forward. In the past, many insurance companies excluded infertility coverage in the event an egg or sperm donor was needed; not allowing for reasons or causes behind the need for donor services. As a result of this exclusion, many patients were forced to stop treatment, or pay 100% out of pocket.”

Paul R. Shin, M.D., a Shady Grove Fertility reproductive urologist and male fertility specialist, also explains why this change is so important, “The prospect of helping couples to achieve their dreams of family building can take many different paths. For the majority of male factor infertility patients who seek their care here at Shady Grove Fertility, those dreams end with a happy healthy baby conceived from the sperm and egg of the male and female partners. However, some men have no sperm and some men with very poor sperm quality can go through an entire IVF cycle and have suboptimal fertilization and embryo development. Without this mandate, the use of donor sperm and the costs associated with uncovered cycles were a significant enough barrier that couples were forced to make a decision based solely on finances, cutting short their dreams of building a family.”

SCHEDULE AN APPOINTMENT

To learn more about the Maryland Insurance Mandate or the use of donor sperm, please contact our New Patient Center at l 1-877-971-7755.

4 Comments

  1. Anonymous

    July 7, 2016 - 6:22 pm
    Reply

    I feel if insurance companies will pay for same sex couples to have a baby, then it should also pay for single women…..

  2. Anonymous

    July 7, 2016 - 4:24 pm
    Reply

    Great news about the insurance mandate and for all the people it will help! Unfortunately, the article did not mention that the mandate fell short to include the other major affected infertility group-women. Excluding donor ovum for women suffering from infertility is blatant discrimination!!! I realize that the cost for donor ovum is much more expensive than sperm donation, but by exclusion it tilts the scale of injustice. The mandate has opened the door a crack, but let’s continue to persevere to bust it wide open for all suffering from infertility!

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