Maine Now Requires Insurance Coverage for Fertility Treatments

Editor’s note: This post was originally published in May, 2022 and was updated in January, 2024 to include the most up-to-date information.

On May 2, 2022, Governor Janet Mills of Maine signed L.D. 1539, “An Act to Provide Access to Fertility Care.” This important legislation requires insurance coverage for fertility treatments in Maine, a service that was not previously mandated.

Before this law, Maine and Vermont were the only New England states without required fertility coverage, leaving families seeking such care in a challenging position. Now, Maine has moved towards increased health coverage, reflecting a positive change for those considering starting or growing their families.

This law officially took effect on January 1, 2024. However, it’s worth noting that the actual start of coverage may depend on open enrollment dates or specific enrollment periods since some employers begin their insurance plans later than the first day of the year. Despite these conditions, this development marks a progressive shift, offering more comprehensive support and care to couples and individuals in Maine.

Understanding Maine’s Fertility Insurance Law

In the simplest terms, this law ensures that insurance companies offering policies in Maine must now include fertility treatments in their coverage. This is a significant step forward for families struggling with fertility issues, as the costs associated with such treatments can often be prohibitively high. It also represents a broader shift in the healthcare landscape, recognizing the importance of comprehensive reproductive healthcare.

It’s important to keep in mind that the basic definition of infertility differs in each state, and, therefore, coverages and exemptions may also look different from state to state.

The legal definition of infertility in Maine is: “An individual or couple with infertility, an individual or couple who is at increased risk of transmitting a serious inheritable genetic or chromosomal abnormality to a child, or an individual unable to conceive as an individual or with a partner because the individual or couple does not have the necessary gametes for conception.”

What Does the Maine Infertility Insurance Mandate Cover?

The law requires insurance to provide coverage for three separate segments of fertility care:

• Fertility Diagnostic Care
• Fertility Treatment
• Fertility Preservation: Preservation that is medically necessary to freeze an egg or sperm before undergoing chemotherapy or any fertility-impairing medical procedure.

It is important to note, though, that while the law mandates coverage, it doesn’t specify the extent of the coverage. This means that insurance providers may still have some discretion in terms of how much of the treatment costs they will cover. Therefore, it’s essential for individuals seeking fertility treatments to consult with their insurance providers to understand the scope of their coverage.

Does the Maine Infertility Insurance Mandate Cover LGBTQ+ Couples and Individuals?

Yes, members of the LGBTQ+ community will be covered by this mandate. At the ceremonial signing for the law, Polly Crozier, Senior Staff Attorney at GLBTQ Legal Advocates & Defenders (GLAD), said, “We’re thrilled to see Governor Mills sign this important, pro-family legislation. This new law will considerably improve access to fertility care for all Mainers hoping to grow their families, including couples with infertility, LGBTQ+ people, cancer survivors and more. Fertility care is critical care for so many people, including LGBTQ+ people. Yet, without insurance coverage, it is out of reach for many due to the cost.”

How To Determine if You Are Eligible for the Maine Infertility Insurance Mandate

If your health insurance is through your job, the first step you should take to determine what your insurance may or may not cover is to talk to your employer or the Human Resources department. Click here for a list of essential questions to ask.

Additionally, you can take these steps to help you determine your eligibility:

Review Your Insurance Policy

Check whether your policy is subject to state law and whether it provides coverage for infertility treatments. If unsure, contact your insurance provider or your employer’s human resources department for clarification.

Check Your Diagnosis (If Applicable)

To be eligible for coverage under the mandate, you typically need an infertility diagnosis from a medical professional. If you’ve been trying to conceive for over a year (or six months if you’re over 35), it might be time to seek a diagnosis.

Consult with a Healthcare Provider

A healthcare provider specializing in reproductive health can guide you through the process, help you understand your options, and provide the documentation needed for insurance.

Contact Us

As part of our continuing efforts to provide more access to fertility care, we have opened a Fertility Centers of New England location in Falmouth, Maine so that we can continue to provide Maine patients with the care they deserve.

Regardless of your insurance coverage, we’re here to help you get the treatment you need. If you have more questions about how Maine will require insurance coverage for fertility treatments or want to inquire about financing options, please reach out to us today!

Editor’s note: This post was originally published in May 2022 and was updated in January 2024 to include the most up-to-date information.