New state law could save patients thousands on prosthetics, fertility and cancer treatment
Starting Jan. 1, state-regulated health plans must cover activity-specific prosthetics, scalp cooling treatment for chemotherapy patients and fertility treatments for single parents and same-sex couples.
More Stories
Patients could save thousands of dollars thanks to a new state law that expands insurance coverage.
Insurers warned that the new mandates could raise premiums, but studies have found it costs pennies on the dollar.
"MORE THAN JUST WALK"
For Rachel Webster, of Wethersfield, the impact could be life changing.
Webster lost her leg at 10 years old to a rare bone cancer called Ewing’s Sarcoma. She was fitted with a prosthetic, but only for walking. Insurance would not cover one for sports.
“Kids need to do more than just walk,” said her mother, Marcy. “They need to run and swim and jump and play and have fun.”
The Webster family’s medical costs have been immense. A GoFundMe has raised $67,000 for Rachel’s bills.
NEW LAW
Starting Jan. 1, state-regulated health plans must cover activity-specific prosthetics.
“If insurance doesn’t cover it, the most amazing technology in the world doesn't make a difference,” Gov. Ned Lamont said at a bill signing ceremony on Tuesday.
The new law also requires insurance to cover scalp cooling caps, which can save chemotherapy patients’ hair. Out of pocket, the treatment can cost up to $3,000.
“Being able to keep much of my hair gave me a sense of control during a time when so much felt out of my hands.” Said cancer survivor Cheryl Hill.
EXPANDED FERTILITY COVERAGE
Non-medical fertility treatment will be covered too.
Right now, many single mothers and same-sex couples have to pay more than $20,000 out-of-pocket. That’s because they don’t qualify as “infertile” under current state law.
“One of our single moms-to-be – she comes in, and she’s been paying her insurance. And what she needs is donor sperm,” Dr. Spencer Richlin, with Illume Fertility in Norwalk, told News 12 Connecticut in 2024. “Since she hasn’t been exposed to sperm, her insurance company – that she has been paying money for – won’t help her.”
Existing law has shut out LGBTQ+ parents.
“The desire to become a parent isn’t defined by your marital status, your sexual orientation or the path you take to get there,” said state Rep. Raghib Allie-Brennan (D-Bethel).
COST DEBATE
The bill passed nearly unanimously earlier this year, but it took years to get these changes passed.
“It was a five-year battle. Five years,” said state Rep. Tammy Nuccio (R-Tolland), the top Republican on the Legislature’s budget committee.
Insurers argued that the new mandates will drive up premiums for everyone.
“Health insurance coverage mandates, while often well-intentioned, add to the increasing costs of health care coverage borne by employers, individuals and the state,” Susan Halpin, executive director of the Connecticut Association of Health Plans, told lawmakers. “Each new mandated benefit incrementally increases premiums, particularly in the fully insured market serving small employers and individuals who are most price sensitive.”
But covering athletic prostheses would only raise Connecticut insurance costs by one to 11 cents per member each month, according to a 2023 analysis.
Costs rose between one and 25 cents in states that already mandate coverage, according to a 2024 study.
“The cost is minimal … while also predicting millions of dollars in cost savings, or cost avoidance, per year on improved health outcomes,” said Maggie Baumer with the So Every BODY Can Move initiative, which commissioned the study. “The insurance plans will still have the ability to use prior authorization to vet these claims.”
NOT EVERYONE BENEFITS
Self-funded plans are regulated by the U.S. Department of Labor and are not subject to state laws.
