Feasibility and effectiveness of a health educational intervention to improve navigation of health insurance benefits for in vitro fertilization: a randomized controlled trial.

PURPOSE: To determine the effectiveness of an educational intervention in improving health insurance literacy and utilization of in vitro fertilization insurance benefits.

METHODS

Randomized controlled trial, with 217 participants randomized in a 2:1 fashion to receive either an educational intervention or university-provided information sheet. Participants were 18 to 50 years, intending to conceive within a year, eligible for employee-offered health insurance coverage. The primary outcome was health insurance literacy. Secondary outcomes included comparing health insurance plans, plan selection, in vitro fertilization service utilization, benefit utilization, out-of-pocket costs, and acceptability, appropriateness, and feasibility of the intervention materials. Semi-structured interviews evaluated participant experiences with intervention materials, plan selection, benefit utilization, in vitro fertilization services, and out-of-pocket costs.

RESULTS

Both groups reported low confidence using their health insurance (intervention: 1.00 [SD = 0.90], usual care: 0.74 [SD = 0.76], β = 0.26, 95% CI - 0.09, 0.62) and moderately high confidence being proactive when using their health insurance (intervention: 2.26 [SD = 0.86], usual care: 2.47 [SD = 0.58], β =  - 0.20, 95% CI - 0.52, 0.11). Utilization of in vitro fertilization services was similar between groups (intervention: 40% [10/25], usual care: 45% [9/20]; p = 0.35). Use of insurance for these services did not differ between groups (intervention: 36% [9/25], usual care: 40% [8/20]; p = 0.78), and both groups experienced moderate out-of-pocket costs. Qualitative data revealed challenges in benefit utilization in both groups.

CONCLUSIONS

Despite the educational intervention not improving health insurance literacy or in vitro fertilization benefit utilization, our findings suggest that being able to navigate health insurance benefits is essential for effective utilization of in vitro fertilization services.

TRIAL REGISTRATION NUMBER: NTC05663645.