Orlando Harmon
IVF treatment is a costly procedure, and insurance coverage can vary depending on the state, the insurance provider, and the individual's plan. While some states, like Illinois, mandate that health insurance plans covering pregnancy must also cover infertility treatments, including IVF, other states, like Texas, only require insurance providers to offer IVF coverage, with employers deciding whether to include it in employee health plans. The cost of IVF treatment can be a financial burden, even for those with insurance, due to high out-of-pocket expenses and unexpected bills.
| Characteristics | Values |
|---|---|
| Cost of IVF treatment | $12,500 for one standard cycle in 2009 |
| Affordability | High costs lead to financial inaccessibility for many |
| Insurance coverage | Varies by state and insurance plan |
| Out-of-pocket expenses | Office visits, diagnostic tests, genetic testing, donor fees, and storage fees |
| State mandates | 15 states require insurance coverage for IVF |
| Employer-provided coverage | May be included in employee health benefit packages |
| Religious organizations | Not required to offer coverage |
| Self-insured employers | Generally exempt from coverage requirements |
| Coverage limitations | May have a lifetime maximum benefit or exclude IVF |
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What You'll Learn
IVF treatment costs
The cost of IVF treatment can vary widely depending on the patient's state of residence, provider, and insurance plan. In the United States, the cost of just one standard cycle of IVF was approximately $12,500 in 2009, but is likely higher today due to rising healthcare costs. Some sources quote the cost of IVF treatment to be as high as $22,000 for women aged 35 and younger, and $24,000 for women aged 36 to 37. This cost typically includes labs, ultrasounds, embryo thaw, and embryo transfer in the package price.
Many patients lack access to fertility services due to their high cost and limited coverage by private insurance and Medicaid. As a result, many people who use fertility services must pay out of pocket, even if they are otherwise insured. In addition to the costs of treatment, patients can face out-of-pocket expenses for office visits, diagnostic tests and procedures, genetic testing, donor sperm/egg use, and storage fees.
Some states, such as New York and Texas, have passed legislation to require insurance providers to offer IVF coverage, although employers ultimately decide whether to include this coverage in employee health plans. It is always recommended to confirm with your employer or insurance company for specific coverage details.
To help with the financial burden, some clinics offer risk-sharing and financing programs, as well as flexible financing options such as 0% APR or low monthly payment plans.
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State-specific insurance coverage
In the United States, federal law does not require health plans to cover infertility treatments, leaving the decision to individual states. As of September 2023, 21 states and the District of Columbia have passed fertility insurance coverage laws, with only 15 of those laws including IVF coverage.
State laws mandating IVF coverage do not apply to self-insured plans, which cover 61% of workers in the US. Additionally, these laws often contain restrictions and discriminatory provisions. For example, Arkansas law stipulates that a patient's eggs must be fertilized with her partner's sperm, excluding LGBTQIA+ couples and single parents. Similar stipulations exist in Texas and Hawaii.
Some states with IVF coverage laws include:
- New York: Requires large group health plans to cover up to three IVF cycles and prescription medications. The law also prohibits insurance coverage discrimination based on age, sex, sexual orientation, marital status, or gender identity.
- Texas: Requires insurance providers to offer infertility coverage, including IVF treatments. However, employers decide whether to include this coverage in employee health plans.
- California: A proposed bill aims to require private plans and Medi-Cal managed care plans to cover IVF services.
Even in states with IVF coverage laws, employers may not be required to cover infertility treatment if they are self-insured or have fewer than 50 employees.
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Employer-provided insurance plans
Whether or not employer-provided insurance plans cover IVF treatment depends on several factors, including the state in which the policyholder lives, the size of their employer, and the specifics of their insurance plan.
In some states, such as California, New York, and Colorado, there are laws mandating that large-group health insurance plans cover IVF treatment. For example, California law, which takes effect in July 2025, requires large-group health insurance plans to cover up to three completed egg retrievals and unlimited embryo transfers. Similarly, Colorado mandates that large-group health plans provide coverage for infertility diagnosis, treatment, and standard fertility preservation services, including up to three completed oocyte retrievals and unlimited embryo transfers. These plans must follow the guidelines of the American Society for Reproductive Medicine (ASRM) and cannot impose higher costs or restrictions on fertility treatments compared to other medical services covered. However, these mandates typically do not apply to small-group health insurance plans or self-funded employer plans, which are regulated by federal law and exempt from state requirements.
Even in states with coverage mandates, not all patients are eligible for IVF treatment. For example, in Hawaii, someone with unexplained infertility must wait five years before qualifying for IVF coverage. Additionally, some laws effectively exclude single individuals and unmarried couples, as they require the use of the couple's own sperm and egg and do not allow for donor options.
While some insurance policies exclude all fertility-related expenses, others may provide coverage for specific aspects of the IVF process, such as diagnostic testing, monitoring, or other related services. It is important to carefully review the insurance plan and contact the insurance provider or HR department to determine the specific coverage details, as well as any out-of-pocket costs, requirements, and reimbursement policies.
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Self-insured employers
In general, fertility treatments are not considered "medically necessary" by insurance companies and are therefore not typically covered by private insurance plans or Medicaid programs. When coverage is available, certain types of fertility services (e.g., testing) are more likely to be covered than others (e.g., IVF).
A handful of states require coverage of fertility services for some fully-insured private plans, which are regulated by the state. However, these requirements do not apply to self-insured plans, which cover 61% of workers with employer-sponsored health insurance.
In Texas, insurance providers are required to offer infertility coverage, including IVF treatments. However, employers decide whether to include this coverage in employee health plans.
In California, under the California Senate Bill 729, enacted in September 2024, fully-insured (non-self-insured) large group health plans will be required to cover the diagnosis and treatment of infertility, including IVF, starting with the first renewal date after July 1, 2025.
In New York, a bill was passed in 2019 to require IVF and fertility preservation services for comprehensive private health insurance policies.
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In-network providers
In the United States, IVF treatment is covered under medical insurance in certain states. However, the availability of coverage varies by provider and plan. For example, Care Health Insurance offers coverage for IVF treatment under its Care Classic plan, while Aetna members can call the Member Services number on their insurance card or refer to their benefit plan documents for details regarding infertility coverage.
As of September 2023, 21 states and the District of Columbia have passed fertility insurance coverage laws, with only 15 of those laws including IVF coverage. These states include Arkansas, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, and Rhode Island. It's important to note that even in these states, employers may not be required to cover infertility treatment if they are self-insured or have specific exemptions.
When it comes to in-network providers, it's important to understand that the coverage and costs can vary. In-network care typically offers more affordable options for patients. For example, a couple with Blue Cross and Blue Shield of Illinois insurance was responsible for 20% of the costs for in-network IVF care, while out-of-network care would have required them to pay 40%.
In some cases, there may be unexpected costs associated with in-network providers. For instance, a couple may need to travel a significant distance to access an in-network IVF specialist or facility. Additionally, certain tests or procedures may need to be performed at out-of-network facilities, resulting in higher out-of-pocket expenses.
It is always advisable to carefully review the terms and conditions of your insurance plan and clarify any questions or concerns with your insurance provider before initiating IVF treatment. Understanding the specific coverage, limitations, and potential out-of-pocket expenses can help you make informed decisions and avoid unexpected financial burdens.
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Frequently asked questions
It depends on the state and the insurance provider. Only 15 states require insurance to cover IVF treatment. In some states, insurance providers are required to offer infertility coverage, but employers decide whether to include this in employee health plans. Some plans cover tests, while others cover tests and IVF cycles.
The cost of just one standard cycle of IVF was approximately $12,500 in 2009, but is likely higher today due to rising healthcare costs. In addition to the treatment costs, patients can be burdened with out-of-pocket expenses for office visits, diagnostic tests and procedures, genetic testing, donor sperm/egg use and storage fees, and wages lost from time off work.
Even when IVF is covered by insurance, patients can be left with high bills, surprises, and hassles. Insurance companies' lists of in-network providers are not always accurate, and patients can be on the hook for out-of-network costs.
Some employers elect to cover the cost of fertility treatment, so it is worth checking with your HR department. Patients can also explore financing options offered by fertility clinics to help manage and reduce fertility treatment costs.
