Does Health Insurance Cover IVF and Other Fertility Treatments?

Overview

In vitro fertilization (IVF) and other fertility treatments can give hope to individuals and couples facing infertility—but they also come with a high price tag. A single IVF cycle can cost $15,000 or more, and many patients need multiple cycles. Because of this, one of the most pressing questions people ask is: Does health insurance cover IVF? The answer depends on your state, your employer’s insurance plan, and federal regulations.

This article explains where coverage is available, common limitations, and how to find out if your plan includes fertility benefits.

Fertility Coverage: An Overview

Health insurance coverage for fertility care is not standardized nationwide. Unlike maternity care, which is considered an essential health benefit under the Affordable Care Act (ACA), fertility services like IVF are not federally required. Instead, states and employers determine what’s covered.

• 21 states currently have some form of fertility insurance mandate, but requirements vary widely. 
• Coverage may range from diagnostic testing only to partial or full IVF benefits. 
• Self-funded employer plans (common among large companies) are regulated by federal law and may not be subject to state mandates. 

State Fertility Mandates

Some states require insurers to cover or offer fertility services. Examples include:

• Massachusetts & Illinois – Require IVF coverage in most employer plans. 
• New York & New Jersey – Mandate IVF coverage for larger employers. 
• California & Texas – Require insurers to offer coverage but not necessarily include it. 

Since laws differ, it’s important to check your state’s insurance department for current rules.

What Fertility Treatments May Be Covered?

Depending on the state and insurer, coverage may include:

• Diagnostic testing for infertility causes 
• Ovulation-inducing medications 
• Intrauterine insemination (IUI) 
• IVF (including egg retrieval, fertilization, and embryo transfer) 
• Fertility preservation (egg or sperm freezing) for cancer patients 

Not typically covered: Experimental treatments, donor eggs/sperm, surrogacy, and elective fertility preservation.

Common Issues & FAQs

Q: Does Medicaid cover IVF?
A: Generally, no. Medicaid does not cover IVF, although some state programs may cover diagnostic or limited treatments.

Q: Does the ACA require IVF coverage?
A: No. The Affordable Care Act does not classify IVF as an essential health benefit.

Q: Is egg freezing covered?
A: Sometimes. States like Illinois require fertility preservation coverage for patients undergoing treatments (like chemotherapy) that may affect fertility.

Actionable Steps to Determine Your Coverage

1. Check your state’s laws – Visit your state insurance department or CMS resources for fertility mandates. 
2. Review your plan’s Summary of Benefits and Coverage (SBC) – Look specifically for fertility or IVF provisions. 
3. Ask your HR or insurance provider – Employer plans may have different rules depending on whether they are self-funded or fully insured. 
4. Plan financially – Even with coverage, IVF often includes out-of-pocket costs like medication or lab fees.
   

Bottom Line 

Whether IVF is covered by health insurance depends on where you live and the type of plan you have. While some states mandate coverage, many do not, and federal law does not require insurers to pay for fertility services. Always check your policy details and state regulations before starting treatment.

Want to know your options? Start by reviewing your plan documents and checking CMS’s state insurance mandate database.