Jeffrey Wade
Fertility treatments are often expensive and out of reach for many people. While some private insurance plans cover diagnostic services, there is little coverage for treatment services such as IUI and IVF. In the US, only one state requires coverage under Medicaid, which is the health coverage program for low-income people. However, fifteen states have passed laws requiring insurers to cover or offer coverage for infertility diagnosis and treatment: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Even in these states, coverage does not always include IVF and other reproductive therapies, and it may not be extended to same-sex couples or single women. Ultimately, the extent of coverage depends on the specific insurance plan.
| Characteristics | Values |
|---|---|
| Infertility definition | Failure to conceive after 12 months of unprotected intercourse for women under 35, or 6 months for women 35 and older |
| Infertility treatments | Medicine, surgery, artificial insemination, assisted reproductive technology (ART), intrauterine insemination (IUI), in-vitro fertilization (IVF) |
| Insurance coverage for infertility treatments | Varies by state and insurance provider; 15-17 states have passed laws requiring insurers to cover or offer coverage for infertility diagnosis and treatment, but specific plans and providers may not include IVF and other reproductive therapies or extend coverage to same-sex couples or single women |
| Insurance providers that cover infertility treatments | Aetna, IVFMD |
| Ways to confirm insurance coverage for infertility treatments | Contact insurance provider directly, consult employee benefits department, refer to benefit plan documents |
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What You'll Learn
Infertility treatment
In the United States, fertility treatments are expensive and often not covered by insurance. While some private insurance plans cover diagnostic services, there is very little coverage for treatment services such as IUI and IVF. However, some states have passed laws mandating that insurers cover or offer coverage for infertility diagnosis and treatment. These states include Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.
Even in states with laws mandating coverage, there may be criteria and exemptions that limit the extent of coverage. For example, coverage may be limited to a certain number of IVF cycles or a maximum amount that insurers must cover. Additionally, self-funded insurance plans may be exempt from state insurance laws, and many fertility treatments are not considered "medically necessary" by insurance companies and are therefore not covered.
To determine if infertility treatment is covered by your insurance, it is best to contact your insurance provider directly or consult your employee benefits department. It is also important to note that even if insurance covers fertility treatments, it does not mean that all costs will be covered, as patients may still be responsible for copays and other out-of-pocket expenses.
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IUI and IVF coverage
Intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are two treatments for infertility. Infertility is defined as a disease or condition characterised by the failure to impregnate or conceive, or the inability to reproduce, after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination for women under 35, or after 6 months for women aged 35 and above.
IUI involves placing sperm inside a woman's uterus to facilitate fertilisation. IVF involves a more complex process of combining eggs and sperm outside the body, in a laboratory, before implanting the resulting embryo into the uterus.
In the US, insurance coverage for IUI and IVF varies by state and by insurance provider. Some states have passed laws requiring insurers to cover or offer coverage for infertility diagnosis and treatment, including Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. However, this does not always include IVF and other reproductive therapies, and may not be extended to same-sex couples or single women.
Some large employers (500 or more employees) offer coverage for some types of fertility services, but most do not cover treatment services such as IVF, IUI, or egg freezing. Coverage is more common among larger employers and those that offer higher wages.
Medicaid, the US government-funded insurance program, does not cover fertility treatments, except in the state of New York, which covers up to 3 cycles of fertility drugs. TRICARE, the insurance program for military families, will cover some infertility services if deemed "medically necessary" and if pregnancy is achieved through "natural conception", meaning fertilization occurs through heterosexual intercourse. IVF is covered by the Veterans Affairs (VA) medical benefits package, if infertility resulted from a service-connected condition.
In general, diagnostic lab tests, semen analysis, and ultrasounds are less expensive than diagnostic procedures or surgery, and treatment using fertility medications is less expensive than IUI and IVF. However, even the less costly treatments can still result in thousands of dollars of out-of-pocket costs.
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Private insurance plans
In the US, 15 states have passed laws requiring insurers to cover or offer coverage for infertility diagnosis and treatment: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. However, this coverage does not always include IVF and other reproductive therapies, and it may not be extended to same-sex couples or single women. For example, in some cases, women under 35 may have to pay out-of-pocket for 12 cycles of IUI or IVF without conceiving, and women over 35 may be required to undergo six unsuccessful cycles.
Even in states that have IVF coverage laws, there may be criteria and exemptions that limit IUI and IVF coverage. Additionally, coverage varies depending on the specific insurance plan. For example, insurance coverage for physician visits, diagnostic testing, and treatment may be provided for women who have been diagnosed with premature ovarian failure before the age of 40, depending on the specific plan.
To determine whether insemination is covered by a private insurance plan, it is best to contact the insurance provider directly or consult the employee benefits department.
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Public insurance plans
No state Medicaid program currently covers artificial insemination (IUI), IVF, or cryopreservation. However, eight states cover some infertility diagnostic services: Georgia, Hawaii, Massachusetts, Michigan, Minnesota, New Hampshire, New Mexico, and New York.
Some states have passed laws requiring insurers to offer coverage for infertility diagnosis and treatment, which may include artificial insemination. These states include Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. However, even in these states, coverage may not always include IVF and other reproductive therapies, and it may not be extended to same-sex couples or single women.
In terms of specific state laws, Maryland mandates that insurance policies in the group market (employers with 50 or more employees) and the individual market cover three rounds of IVF per live birth, with a lifetime benefit cap of $100,000. Massachusetts requires all individual and group policies providing pregnancy-related benefits to cover the diagnosis and treatment of infertility, including artificial insemination, IVF, GIFT, ICSI, and ZIFT. Colorado requires large-group plans (over 100 employees) to cover the diagnosis and treatment of infertility and fertility preservation services, with cost-sharing comparable to other medical services under the plan. Connecticut mandates that individual and group plans cover a range of fertility treatments, including ovulation induction, intrauterine transfer (IUI), IVF, GIFT, and ZIFT, with applicable lifetime limits.
Starting in 2026, Washington, D.C.'s essential health benefits benchmark plan will include coverage for "all procedures consistent with established medical practices by licensed physicians and surgeons to treat infertility." Hawaii requires individual and group plans to cover one cycle of IVF for patients meeting certain criteria, with cost-sharing comparable to other covered services. Illinois mandates that group health plans (employers with 25 or more employees) and HMOs providing pregnancy-related coverage cover a range of infertility treatments, including diagnosis, artificial insemination, IVF, GIFT, and ZIFT, with cost-sharing comparable to other medical care.
It is important to note that insurance coverage for infertility treatments can vary widely, and it is always best to check with your specific insurance provider to understand your coverage options.
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State-by-state coverage
As of September 2023, 21 states and the District of Columbia have passed fertility insurance coverage laws. However, only 15 of those laws include IVF coverage, and 17 laws cover fertility preservation services for iatrogenic, or medically-induced, infertility.
Even in these states, employers may not be required to cover infertility treatment and fertility preservation services if they are self-insured, or if they have fewer than 50 employees and are not mandated to provide health insurance coverage. Religious organizations may also be exempt.
- 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 cannot exceed $100,000.
- Massachusetts: All individual and group policies providing pregnancy-related benefits must cover the diagnosis and treatment of infertility. Treatment includes (but is not limited to) artificial insemination, IVF, GIFT, ICSI (intracytoplasmic sperm injection), and ZIFT.
- New York: 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, not state law.
- Colorado: State law requires large-group plans (more than 100 employees) to cover the 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. Individual and small-group plans must cover the diagnosis of infertility and artificial insemination, due to Colorado's ACA EHB benchmark plan.
- Connecticut: State law requires individual and group plans to cover a wide range of fertility treatments, including ovulation induction, intrauterine transfer (IUI), IVF, gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT).
- Ohio: Law requires HMOs to cover medically necessary preventive "basic health care services," including infertility services related to the diagnosis and correction of issues such as endometriosis. However, Ohio law does not mandate coverage of IVF, GIFT, or ZIFT.
- Hawaii: 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: 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 cannot exceed cost-sharing for medical care unrelated to infertility.
It is important to note that insurance coverage for fertility treatments can vary depending on the state of residence, the type of insurance (public or private), and the specific insurance plan. Even with insurance, there may be out-of-pocket expenses for office visits, diagnostic tests, genetic testing, donor sperm/egg use, and storage fees.
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Frequently asked questions
It depends on your insurance provider and your state of residence. In the US, 15-17 states have passed laws requiring insurers to cover or offer coverage for infertility diagnosis and treatment, but even in these states, coverage may not include insemination.
Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.
Infertility means a disease or condition that results in impaired function of the reproductive system, whereby an individual is unable to procreate or carry a pregnancy to full term.
Treatments include medicine, surgery, artificial insemination, or assisted reproductive technology (ART).
Contact your insurance provider directly to confirm. Consult your employee benefits department and refer to your benefit plan documents for details regarding infertility coverage.
