Does health insurance cover IVF and other fertility treatments?

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.

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.⁶ And the majority of people with employer-sponsored health insurance in the United States are covered under self-insured plans.⁷

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.⁵

State-by-state laws requiring coverage of infertility

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:²³

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, and DC’s EHB benchmark is being expanded to include extensive fertility treatments in 2026.¹²)
• 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
• Washington (starting in 2026¹²)

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
• DC (2026 update to EHB benchmark includes full spectrum of fertility treatment;¹² as noted above, more extensive coverage starts in 2025 due to state legislation)

California plans to update its EHB benchmark plan starting with the 2027 plan year. One of the potential benefit additions under consideration is services to treat infertility.²⁴

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. Washington’s EHB benchmark plan is being updated to include coverage of artificial insemination starting in 2026, and DC’s EHB benchmark plan is also being updated in 2026 to include coverage of the full range of fertility treatments (as noted above, DC will already require extensive fertility coverage as of 2025, under the terms of state legislation enacted in 2023).

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

• California (SB729, enacted in September 2024, requires state-regulated large group plans — but not individual plans or small group plans — to cover the diagnosis and treatment of infertility, including IVF, starting in 2026 for calendar-year plans.)⁹
• Oklahoma (SB1334, signed into law in May 2024, requires health plans to cover fertility preservation only.)²⁵
• New Jersey (A2002 would require carriers to cover fertility preservation when diagnosed with certain menstrual disorders.)²⁶
• New York (S9535 would require individual health plans to cover IVF, as is already the case for large group plans in NY.)²⁷

Several other states considered legislation in 2024 related to fertility coverage, but the bills were unsuccessful:

• Tennessee (HB2549, SB2629, HB2064, and SB1935 would have required coverage of fertility preservation only.)²⁸
• Maryland (HB985 would have added coverage of fertility treatment to Medicaid.)²⁹
• Minnesota (HF1658 would have required coverage of infertility diagnosis and treatment on all state-regulated health plans and Medicaid.)³⁰
• Mississippi (SB2781 would have required coverage of fertility preservation only)³¹
• Missouri (HB2341 would have required coverage for IVF.)³²
• New Hampshire (SB558 would have required group plans to cover up to six rounds of IUI per year.)³³
• Virginia (HB560 would have required coverage of fertility treatment and would have recommended that such coverage be included in an updated essential health benefits benchmark plan for Virginia.)³⁴
• West Virginia (HB4024 would have required health plans to cover various infertility treatments.)³⁵

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.

For example, as noted above, California is in the process of updating its EHB benchmark plan for 2027, and one of the potential benefit additions under consideration is the treatment of infertility.²⁴

And both DC and Washington have received approval to update their EHB benchmark plans starting in 2026 to include various fertility benefits.¹²

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.³⁶

Of those with employer-sponsored health benefits, 65% of covered workers are in self-insured plans,³⁷ 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.³⁸)

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.

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. ”U.S. Senate Bill 4445” “U.S. House Resolution 4731” “U.S. Senate Bill 2386” and “U.S. House Resolution 9643” BillTrack50. Accessed Oct. 10, 2024 ⤶
5. “Insurance Coverage by State” Resolve, the National Infertility Association. Accessed April 26, 2024 ⤶ ⤶
6. “A primer on ERISA’s preemption of state laws” Mercer. March 22, 2022 ⤶
7. “Employer Health Benefits, 2023 Annual Survey” KFF. Page 11. Oct. 18, 2023 ⤶
8. “See Plans & Prices” HealthCare.gov. And “2024 Exchange PUF Datasets” (Plan Attributes PUF, lines 17346-17649) CMS.gov. Accessed May 15, 2024 ⤶
9. “California SB729” BillTrack50. Enacted Sep. 29, 2024. ⤶ ⤶
10. ”California Governor Signs New IVF Insurance Mandate” Newfront. Oct. 1, 2024 ⤶
11. “DC B25-0034 Expanding Access to Fertility Treatment Amendment Act of 2023” BillTrack50. Enacted July 14, 2023 ⤶
12. ”CMS Approves Essential Health Benefits Benchmark Plans for Two States and DC” CMS Newsroom. Oct. 18, 2024 ⤶ ⤶ ⤶ ⤶ ⤶
13. “ME LD1539 An Act To Provide Access to Fertility Care” BillTrack50. Enacted April 25, 2022 ⤶
14. “Chapter 865: Standards for Fertility Coverage” Maine Bureau of Insurance. Accessed May 1, 2024 ⤶
15. “ Code Ann. § 33-31-102(3)” Montana Code Annotated 2023. Accessed April 30, 2024 ⤶
16. “See Plans & Prices” HealthCare.gov. Accessed April 30, 2024 ⤶ ⤶
17. “MT SB516 Provide for the Preserving Fertility Act” BillTrack50. Enacted June 29, 2023 ⤶
18. “SB 198 Expanded Access to Assisted Reproductive Treatments” New Hampshire Insurance Department. September 15, 2023 ⤶
19. “Bulletin 2009-07” Ohio Department of Insurance. Accessed April 30, 2024 ⤶
20. “Utah SB35 Infertility Treatment Coverage Amendments” BillTrack50. Enacted March 19, 2024 ⤶
21. “Infertility treatment coverage bill nears passing the Utah Legislature” State of Reform. Feb. 15, 2024 ⤶
22. “Infertility Services — Minimum Benefits” West Virginia Offices of the Insurance Commissioner. Accessed May 1, 2024 ⤶
23. ”Information on Essential Health Benefits (EHB) Benchmark Plans” CMS.gov. Accessed May 15, 2024 ⤶
24. ”Public Meeting on California’s Essential Health Benefits and Updating the Benchmark Plan” California Department of Managed Health Care. June 27, 2024 ⤶ ⤶
25. “Oklahoma SB1334” BillTrack50. Enacted May 28, 2024. ⤶
26. “New Jersey A2002” Introduced Jan. 9, 2024. ⤶
27. ”New York S9535” BillTrack50. In committee May 16, 2024 ⤶
28. “Tennessee HB2549, Tennessee SB2629, Tennessee HB2064, and Tennessee SB1935” Introduced January 2024. ⤶
29. “Maryland HB985” Introduced February 2024. ⤶
30. “Minnesota HF1658” Legislation failed as of May 2024. ⤶
31. ”Mississippi SB2781” BillTrack50. Legislation failed March 5, 2024 ⤶
32. ”Missouri HB2341” BillTrack50. Legislation failed May 17, 2024 ⤶
33. “New Hampshire SB558” Passed Senate April 11, 2024, did not advance in the House, dead as of June 2024 ⤶
34. ”Virginia HB560” BillTrack50. Legislation failed Feb. 13, 2024 ⤶
35. ”West Virginia HB4024” BillTrack50. Legislation failed March 30, 2024 ⤶
36. “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 ⤶
37. “2023 Employer Health Benefit Survey” KFF. Oct. 18, 2023 ⤶
38. “Market Rating Reforms; State-Specific Rating Variations” CMS.gov. Accessed April 30, 2024 ⤶
39. “Coverage and Use of Fertility Services in the U.S.” KFF. Sept. 15, 2020 ⤶ ⤶
40. “Medicaid Coverage of Limited Infertility Benefit” New York State Department of Health. Accessed May 1, 2024 ⤶
41. “§ 31–3834.06(c). Coverage of fertility treatments” Council of the District of Columbia. Accessed May 1, 2024 ⤶
42. “Few states extend fertility treatment coverage to Medicaid recipients” Ohio Capital Journal. Aug. 15, 2023 ⤶