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Does health insurance cover IVF and other fertility treatments?

Does the ACA require infertility treatment to be covered by health insurance?

According to the World Health Organization, infertility affects approximately one in six adults worldwide.1 And a single cycle of in vitro fertilization (IVF) will generally cost between $15,000 and $20,000.2 It’s easy to see why the question of insurance coverage for infertility and IVF is often asked.

Unfortunately, the answer to whether insurance covers IVF isn’t a simple yes or no. Health insurance coverage for IVF and other fertility treatments varies from one state to another and from one health plan to another.

Do federal and state laws require health plans to cover infertility treatment?

Federal law does not require any health plans to cover infertility treatment.3 The Affordable Care Act (Obamacare) requires individual and small-group health plans to cover 10 essential health benefits (EHB). However, assisted reproductive technology is not considered an EHB unless a state specifically chooses to require this coverage. (See below for more details about this).

As of late 2023, 21 states and the District of Columbia had enacted laws requiring at least some coverage for infertility services on at least some state-regulated health plans.4 These are discussed in more detail below.

  • In most of those states, there’s a requirement that some or all state-regulated health plans cover fertility preservation before a medical treatment that’s expected to harm a person’s fertility.
  • In most of those states, there’s a requirement that some or all state-regulated plans cover the process of diagnosing infertility. But state rules requiring health plans to cover IVF are much less common.
  • There are only nine states (details below) where state law or the state’s Essential Health Benefits benchmark plan includes an IVF coverage requirement for individual/family health policies (DC will join this list in 2025).
  • There are four states where the IVF coverage requirement only applies to large group plans.
  • In two states (California and Texas), insurers that offer group health plans must offer coverage for at least some infertility treatment, but employers get to decide whether to provide this benefit to their employees.


Limitations of state laws and variations in state regulations

Before we get to a summary of state rules, it’s important to clarify that state insurance mandates never apply to self-insured group plans.5 And the majority of people with employer-sponsored health insurance in the United States are covered under self-insured plans.6

So states can impose coverage requirements on individual/family health plans and small- or large-group health plans that are fully insured (meaning they are purchased from an insurance company as opposed to being self-insured by the employer). But those requirements do not apply to self-insured group plans.

It’s also important to note that states can make rules that apply only to certain types of coverage, but not to all state-regulated health plans. And although there are 21 states that have imposed some level of fertility coverage requirements on at least some state-regulated health plans, the specifics vary quite a bit state-to-state in terms of what plans are affected and what services have to be covered.

There are numerous state-to-state variations that are important to keep in mind, including:

  • How infertility is defined (for example, how long a couple must try to conceive before coverage becomes available),
  • Age limits for coverage,
  • Whether same-sex couples or single parents are eligible for coverage,
  • Whether donor eggs or sperm are covered or can be used,
  • Whether the policy must have been in force for a certain amount of time before the coverage is applicable,
  • Whether less-expensive procedures (IUI, for example) must fail before more expensive procedures (IVF, for example) can be covered.
  • For fertility preservation, whether the coverage applies to any medical treatment that could result in infertility, or only to cancer treatment that could result in infertility.

There also tend to be exceptions for religious employers, as well as exclusions on coverage of infertility treatment to address the reversal of a voluntary sterilization procedure.

With all of that in mind, the following states have laws that require insurers to cover the diagnosis of infertility, treatment of infertility (which can include IVF), and/or fertility preservation services.4

State-by-state laws requiring coverage of infertility

The information below highlights various state requirements, but as noted above, there is significant variation in terms of their applicability. Always check the specific coverage details of any plan you’re considering.


Arkansas

  • In Arkansas, individual and group policies that offer maternity benefits must cover IVF, but HMOs are not required to cover IVF. The POS plans available in the individual market in Arkansas are regulated as HMOs.7
  • Other individual and group insurance policies that provide maternity benefits must cover in vitro fertilization (IVF) with the same cost-sharing that applies to other maternity benefits.
  • The IVF benefit can have a lifetime maximum of $15,000.


California

  • California state law requires an insurer to cover fertility preservation if a covered medical treatment (for example, chemotherapy, radiation, or surgery) is expected to result in infertility.
  • State law does not require an insurer to cover Infertility treatment. But insurers that provide group coverage are required to offer coverage for infertility diagnosis, diagnostic testing, medication, surgery, and Gamete Intrafallopian Transfer (GIFT). It is then up to the employer to decide whether to offer those benefits to employees. (Note that state law does not require an insurer to offer IVF coverage.)


Colorado

  • Colorado state law requires large-group (more than 100 employees) plans to cover diagnosis and treatment of infertility, and fertility preservation services, with cost-sharing that doesn’t exceed the cost-sharing for other medical services under the plan.
  • The plan must cover three completed oocyte retrievals and unlimited embryo transfers.
  • As explained below, individual and small-group plans must cover the diagnosis of infertility and artificial insemination, but this is due to Colorado’s ACA EHB benchmark plan, as opposed to a state law.


Connecticut

  • Connecticut state law requires Individual and group plans to cover a wide range of fertility treatments, including ovulation induction, intra uterine transfer (IUI), IVF, gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). (Lifetime limits are applicable and vary for each service.)


Delaware

  • Delaware state law requires group policies (for employers with 50 or more employees) and individual policies that cover medical or hospital expenses to cover a wide range of fertility treatments, including IVF.
  • The policies must also cover fertility preservation services before a covered treatment that may cause infertility.
  • Cost-sharing cannot exceed the cost-sharing for medical care unrelated to fertility.


District of Columbia

  • Per DC statute, starting in 2025, plans offered through DC Health Link (the only way to obtain individual/family coverage in DC) and employer-sponsored plans will cover the diagnosis of infertility, three rounds of IVF, and an embryo transfer to a surrogate, if necessary.
  • The plans will also cover fertility preservation services before a person undergoes medical treatment that could result in infertility.
  • As of 2024, DC residents enrolled in Medicaid or DC Healthcare Alliance have coverage for infertility diagnosis and up to three cycles of ovulation-enhancing medications.
  • DC’s rules stem from legislation that was enacted in 2023.8


Hawaii

  • Under Hawaii state law, individual and group plans must cover one cycle of IVF for patients meeting certain criteria, with the same cost-sharing that applies to other covered services.


Illinois

  • Under Illinois state law, group health plans (if the employer has 25 or more employees) and HMOs that provide pregnancy related coverage must cover a range of infertility treatments, including diagnosis, artificial insemination, IVF, GIFT, and ZIFT.
  • Cost-sharing can’t exceed cost-sharing for medical care unrelated to infertility.
  • Individual and group plans must cover fertility preservation services before a covered medical treatment that could result in infertility.
  • As explained below, IVF and other fertility treatments are covered on individual and small-group plans due to the state’s ACA Essential Health Benefits (EHB) benchmark plan, as opposed to a state law.


Kentucky

  • Kentucky state law requires all health plans to cover fertility preservation services before a covered medical treatment that could result in infertility.


Louisiana

  • Louisiana state law requires all health plans to cover fertility preservation services before a covered cancer treatment that could result in infertility.


Maine

  • Under Maine state law, as of 2024 (under legislation enacted in 2022),9 health plans must cover the diagnosis and treatment of infertility (including IVF) if the plan provides pregnancy-related benefits.10
  • Under the same legislation, health plans must cover fertility preservation services before a medical treatment that could result in infertility.


Maryland

  • Maryland state law mandates that insurance policies issued in the group market (if the employer has 50 or more employees) and in the individual market are required to cover three rounds of IVF per live birth.
  • The lifetime benefit cap for fertility treatments can’t exceed a maximum of $100,000.


Massachusetts

  • Under Massachusetts state law, all individual and group policies providing pregnancy-related benefits have to cover the diagnosis and treatment of infertility.
  • Treatment includes (but is not limited to) artificial insemination, IVF, GIFT, ICSI (intracytoplasmic sperm injection), and ZIFT.
  • Cost-sharing cannot exceed cost-sharing for medical care not related to infertility. But insurers can set their own coverage limits — for example, how many rounds of IVF will be covered.


Montana

  • A Montana statute requires HMOs to cover infertility care under “basic health care services.” But the statute does not define what has to be covered,11 (There are no HMOs for sale in the Montana Marketplace as of 2024.12)
  • As of 2024, a Montana law mandates that fertility preservation services have to be covered if a member is diagnosed with cancer and the treatment could result in infertility. This stems from SB516, which was enacted in 2023.13
  • As explained below, individual and small-group plans must cover the diagnosis of infertility and artificial insemination, but this is due to Montana’s ACA EHB benchmark plan, as opposed to a state law.


New Hampshire

  • New Hampshire state law requires large-group health plans to cover the diagnosis of the cause of infertility, and medically necessary fertility treatment. (The state clarifies that this does include IVF).14
  • Cost-sharing can’t be higher than the cost-sharing for medical services unrelated to infertility.
  • As explained below, individual and small-group plans must cover the diagnosis of infertility and treatment of the underlying causes of infertility, but this is due to New Hampshire’s ACA EHB benchmark plan, rather than a state law.


New Jersey

  • New Jersey law requires large-group plans (employers with 50 or more employees) that provide pregnancy related coverage to provide coverage for a wide range of fertility treatment, including (but not limited to) IVF, ICSI, GIFT, and ZIFT.
  • Large-group plans must also cover fertility preservation before a covered medical treatment that may cause infertility.


New York

  • New York state law requires group policies to cover tests and procedures necessary for the diagnosis of infertility.
  • Large-group policies (employers with 100 or more employees) must cover up to three IVF cycles.
  • The state law does not require insurers to cover IVF in the individual market or the small-group market. No policies are required to cover GIFT or ZIFT.
  • Individual and group policies must cover fertility preservation before a covered medical treatment that could result in infertility.
  • As explained below, individual and small-group plans must cover the diagnosis of infertility and artificial insemination, but this is due to New York’s ACA EHB benchmark plan, as opposed to a state law.


Ohio

  • Ohio law requires HMOs to cover medically necessary preventive “basic health care services,” including infertility services. But this only means services related to the diagnosis of infertility, and the correction of an issue such as endometriosis.15 (All of the plans for sale in 2024 in Ohio’s Marketplace are HMOs.12)
  • Ohio law does not require HMOs (or any other plans) to cover IVF, GIFT or ZIFT.


Rhode Island

  • Rhode Island state law requires health plans that cover pregnancy benefits to cover the diagnosis and treatment of infertility, up to a $100,000 benefit cap. Insurers can require the patient to pay 20% of the cost.
  • Health plans must cover fertility preservation services before a covered medical treatment that could cause infertility.


Texas

  • Under Texas state law, insurers in the group market must offer fertility coverage, including coverage for IVF. But employers can choose whether to provide this benefit to their employees.
  • Health plans must cover fertility preservation before cancer treatment that could result in infertility.


Utah

  • Utah’s coverage requirement applies only to the Utah Public Employees’ Health Plan. This was previously a pilot program, scheduled to sunset at the end of 2024, but it was made permanent by Utah SB35, enacted in 2024.16 The program provides an indemnity benefit of $4,000 per single embryo implant.17


West Virginia

  • West Virginia state law requires HMOs to cover infertility services, but the state has clarified that this only means the diagnosis of infertility, and not treatment such as IVF.18
  • As explained below, individual and small-group plans must cover the diagnosis of infertility and treatment of the underlying causes of infertility, but this is due to West Virginia’s ACA EHB benchmark plan, rather than a state law.

States with infertility coverage in their EHB benchmark plan

If a state’s Essential Health Benefits (EHB) benchmark plan includes coverage for infertility treatment, all ACA-compliant individual and small-group health plans in the state (meaning non-grandfathered/grandmothered plans) must also cover – at a minimum – those same services.

There is quite a bit of overlap between states that have some level of infertility coverage in their EHB benchmark plan and the states listed above that have laws requiring some level of infertility coverage for individual and small-group health plans.

But some states that don’t have laws requiring infertility coverage do have some level of infertility coverage in their EHB benchmark plan. That will mean that all individual and small-group plans in those states must provide at least the same benefits as the EHB benchmark plan, even though there isn’t a specific coverage law in the state.

But most of the EHB benchmark plans that include infertility coverage limit it to coverage of diagnosis of infertility and some lower-cost treatment options. Here’s a summary:19

Two states and DC have EHB benchmark plans that include coverage for the diagnosis of infertility:

  • Arizona
  • DC (as noted above, more extensive coverage starts in 2025)
  • Tennessee

Seven states have EHB benchmark plans that include coverage for the diagnosis of infertility and treatment of the underlying causes of infertility (for example, removing uterine fibroids):

  • Kansas
  • Michigan
  • Missouri
  • New Hampshire
  • New Mexico (as of 2022)
  • Virginia
  • West Virginia

The EHB benchmark plans in five states include coverage for the diagnosis of infertility and artificial insemination:

  • Montana
  • Nevada
  • New York
  • Pennsylvania
  • Colorado

The EHB benchmark plans in two states include the diagnosis of infertility and medical stimulation of ovulation:

  • Iowa
  • North Carolina

In five states, the EHB benchmark plans include more comprehensive coverage, including IVF coverage. But as noted above, most of these states also have laws requiring this coverage for individual and small group plans:

  • Connecticut
  • Hawaii
  • Illinois (State law only requires coverage on group plans with 25 or more employees, but the EHB benchmark extends this coverage to individual and smaller group plans.)
  • Maryland
  • Massachusetts

Evolving state requirements for infertility coverage

The lists above show states where either a law or EHB benchmark plan requires some degree of infertility coverage on at least some health plans. The District of Columbia and six states — Colorado, Delaware, Maine, New Hampshire, New Mexico, and Utah — have joined those lists since 2018, due to new state laws or, in the case of New Mexico, an updated EHB benchmark plan.

Legislators in a handful of other states are considering adopting legislation in 2024 that would require some degree of infertility coverage on some plans:

  • Oklahoma (SB1334 would require health plans to cover fertility preservation only.)20
  • Tennessee (HB2549, SB2629, HB2064, and SB1935 would require coverage of fertility preservation only.)21
  • Maryland (HB985 would add coverage of fertility treatment to Medicaid.)22
  • Minnesota (HF1658 would require coverage of infertility diagnosis and treatment on all state-regulated health plans and Medicaid.)23
  • New Hampshire (SB558 would require group plans to cover up to six rounds of IUI per year.)24
  • New Jersey (A2002 would require carriers to cover fertility preservation when diagnosed with certain menstrual disorders.)25

Under rules finalized by HHS in 2024, it will be easier for states to modify their EHB benchmark plans and add required benefits. So we might see some states adjust their EHB benchmark plans to include various levels of fertility coverage in future years.

How to get IVF covered by insurance, along with other infertility treatments and tests

No matter where you are on your reproductive journey, you may need help understanding the infertility insurance landscape.

If you’re in need of infertility testing or treatment, here are some questions you’ll want to ask your health plan, broker, or human resources department to make sure you understand your coverage and can access any benefits that might be available to you:

  • Does my plan offer any benefits related to infertility? And if so, how does the plan define infertility?
  • Does my plan cover office visits, tests, and procedures necessary for the diagnosis of infertility?
  • Does my plan cover any treatments for infertility, including IUI, IVF, etc.?
  • If so, what are the coverage limitations (rounds of treatment, dollar limit, etc.) and what can I expect in terms of out-of-pocket costs?
  • If the plan provides any infertility benefits, am I limited to only using in-network providers, or is there also any out-of-network coverage?

How various types of health insurance cover IVF

Here’s an overview of the various types of health insurance and what you can expect when it comes to IVF coverage:

ACA Marketplace coverage

If you buy your own health insurance — as opposed to getting coverage from an employer, Medicare, or Medicaid — coverage for IVF is going to depend almost entirely on the state where you live. It’s possible for individual/family health plans (including Marketplace plans and off-Marketplace plans) to offer fertility coverage even if it’s not required, but this is very unlikely.

If you’re in Arkansas (PPOs only), Connecticut, Delaware, DC (as of 2025), Hawaii, Illinois, Maine, Maryland, Massachusetts, or Rhode Island, the plans available in the individual market – including Marketplace plans – will cover IVF. The coverage rules and limitations will vary by state, and out-of-pocket costs will vary by plan.

If you’re in one of the other states listed above where state laws or EHB benchmark rules require infertility coverage, the specifics of what’s covered will vary by state (for example, fertility preservation services, diagnosis of infertility, etc.).

Employer-sponsored group health plan

Employer-sponsored health insurance covers nearly half of all individuals in the United States, and is by far the nation’s largest coverage sector.26

Of those with employer-sponsored health benefits, 65% of covered workers are in self-insured plans,27 which aren’t subject to state insurance laws or mandates. For these plans, coverage of fertility services is entirely up to the employer.

If you’re enrolled in an employer-sponsored plan that your employer purchases from an insurance company, coverage of infertility services will depend on the size of your employer (small-group plans and large-group plans can have different rules) and the state where the plan is based.

(See details above regarding the laws in various states. Note that if the coverage rule stems from the EHB benchmark as opposed to a state law, the requirement won’t apply to large-group plans. In most states, large-group coverage applies to employers with 50 or more employees.28)


Does Medicaid cover IVF and other fertility treatments?

There are no states where Medicaid will cover IVF or IUI. And coverage of other fertility services tends to be quite limited for Medicaid enrollees.29

New York’s Medicaid program covers up to three cycles of fertility medications.30 As of 2024, Washington, DC Medicaid and DC Healthcare Alliance provide coverage for infertility diagnosis and up to three cycles of fertility medications.31 And Illinois Medicaid will cover fertility preservation before a covered medical treatment that could cause infertility.32

There are also several states that provide Medicaid coverage for some aspects of infertility diagnosis. But by and large, Medicaid programs in most states do not provide any benefits related to fertility.29


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Footnotes

  1. 1 in 6 people globally affected by infertility” World Health Organization. April 4, 2023 
  2. How much does IVF cost?” Forbes Health. April 14, 2023 
  3. Healthcare Policy: Federally Mandated Insurance Coverage for Infertility Treatment” Columbia Social Work Review. May 4, 2021 
  4. Insurance Coverage by State” Resolve, the National Infertility Association. Accessed April 26, 2024  
  5. A primer on ERISA’s preemption of state laws” Mercer. March 22, 2022 
  6. Employer Health Benefits, 2023 Annual Survey” KFF. Page 11. Oct. 18, 2023 
  7. See Plans & Prices” HealthCare.gov. And “2024 Exchange PUF Datasets” (Plan Attributes PUF, lines 17346-17649) CMS.gov. Accessed May 15, 2024 
  8. DC B25-0034 Expanding Access to Fertility Treatment Amendment Act of 2023” BillTrack50. Enacted July 14, 2023 
  9. ME LD1539 An Act To Provide Access to Fertility Care” BillTrack50. Enacted April 25, 2022 
  10. Chapter 865: Standards for Fertility Coverage” Maine Bureau of Insurance. Accessed May 1, 2024 
  11. Code Ann. § 33-31-102(3)” Montana Code Annotated 2023. Accessed April 30, 2024 
  12. See Plans & Prices” HealthCare.gov. Accessed April 30, 2024  
  13. MT SB516 Provide for the Preserving Fertility Act” BillTrack50. Enacted June 29, 2023 
  14. SB 198 Expanded Access to Assisted Reproductive Treatments” New Hampshire Insurance Department. September 15, 2023 
  15. Bulletin 2009-07” Ohio Department of Insurance. Accessed April 30, 2024 
  16. Utah SB35 Infertility Treatment Coverage Amendments” BillTrack50. Enacted March 19, 2024 
  17. Infertility treatment coverage bill nears passing the Utah Legislature” State of Reform. Feb. 15, 2024 
  18. Infertility Services — Minimum Benefits” West Virginia Offices of the Insurance Commissioner. Accessed May 1, 2024 
  19. Information on Essential Health Benefits (EHB) Benchmark Plans” CMS.gov. Accessed May 15, 2024 
  20. Oklahoma SB1334 Passed both chambers; reconciliation process began April 22, 2024. 
  21. Tennessee HB2549, Tennessee SB2629, Tennessee HB2064, and Tennessee SB1935 Introduced January 2024. 
  22. Maryland HB985 Introduced February 2024. 
  23. Minnesota HF1658 In committee March 11, 2024. 
  24. New Hampshire SB558 Passed Senate April 11, 2024. 
  25. New Jersey A2002 Introduced Jan. 9, 2024. 
  26. Health Coverage of the Total Population, 2022” KFF. Accessed April 30, 2024.] And overall, the number of employer-sponsored plans that cover IVF and other fertility treatments has been increasing significantly in recent years, particularly among large employers. Forty-three percent of large employers covered IVF in 2022, up from 27% in 2020.[efn_note]“The next wave in inclusive family planning support” Mercer. Sept. 28, 2023 
  27. 2023 Employer Health Benefit Survey” KFF. Oct. 18, 2023 
  28. Market Rating Reforms; State-Specific Rating Variations” CMS.gov. Accessed April 30, 2024 
  29. Coverage and Use of Fertility Services in the U.S.” KFF. Sept. 15, 2020  
  30. Medicaid Coverage of Limited Infertility Benefit” New York State Department of Health. Accessed May 1, 2024 
  31. § 31–3834.06(c). Coverage of fertility treatments” Council of the District of Columbia. Accessed May 1, 2024 
  32. Few states extend fertility treatment coverage to Medicaid recipients” Ohio Capital Journal. Aug. 15, 2023 
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