Many people wonder if they can purchase infertility Insurance to help cover the often substantial costs of fertility testing and treatments. The availability, coverage scope, and eligibility for infertility insurance or fertility coverage depend on several factors, including your location, health plan type, employer benefits, and evolving state laws. This page examines how infertility insurance works, who may qualify, key coverage features, and actionable next steps for those exploring this specialized type of health insurance in the United States.
Direct Answer
It is generally possible to obtain insurance that includes some infertility or fertility coverage, but plans and coverage scope vary significantly by state and insurer.
Some U.S. states mandate insurance coverage for certain fertility services; in others, such coverage is optional or excluded.
Fertility coverage is often available through employer group plans; individual/Marketplace plans may include it in select states but typically do not as a standard benefit.
Covered services, such as infertility testing, in vitro fertilization (IVF), or medications, frequently have limits, waiting periods, or prerequisites like prior medical testing.
Premiums are generally higher for plans with expanded fertility benefits; out-of-pocket costs, copays, and coinsurance can apply.
You cannot add comprehensive infertility insurance to just any plan at will; eligibility is determined by plan options, open enrollment rules, and sometimes underwriting.
Coverage and rules change frequently. Always verify current-year details on Healthcare.gov, your state insurance department, or directly with your health plan.
Who This Policy Is For & Eligibility
Individuals, couples, or families seeking coverage for infertility diagnosis and treatment, including those planning for IVF or other assisted reproductive technologies.
Eligibility varies by plan—some require a diagnosis of infertility, defined as unsuccessful conception after one year of unprotected sex (six months if over age 35).
Some state-regulated employer group plans may include fertility benefits as mandated by law; large self-funded employer plans and small group or individual plans may be exempt from state mandates and may not include infertility coverage.
Enrollment in a new policy with fertility benefits is typically possible during annual open enrollment windows or a special enrollment period (SEP) triggered by qualifying life events (e.g., marriage, birth, loss of coverage); these windows vary by year and state.
If you’re already pregnant or receiving fertility services, pre-existing condition rules may influence coverage for ongoing but not future pregnancies.
Key Facts (At-a-Glance)
Item
Details
Coverage Types
Typically includes diagnostic testing, IUI, IVF, medications, egg/sperm preservation, sometimes counseling. Scope and availability differ by plan/state.
Premium
Monthly premium is generally higher for plans including infertility coverage. Check plan SBC; “sample/illustrative” rates only.
Deductible
You must pay an annual deductible before most plan benefits apply. Fertility services may have separate cost-sharing.
Copay/Coinsurance
Plans may require a copay or coinsurance for office visits, testing, or procedures. Amounts vary widely.
Out-of-Pocket Maximum
Annual cap on total in-network spending; once reached, covered in-network costs are paid at 100%.
Referrals/Preauthorization
Referrals from your primary doctor and insurer preauthorization are common requirements for accessing fertility specialists and procedures.
Drug Formulary
Fertility drugs may fall into specialty tiers and require prior authorization; coverage subject to plan’s formulary and rules.
Enrollment Windows
Annual open enrollment (Marketplace: usually November–January; employer plans: varies) and limited SEPs; verify on official portals.
Pros
May cover expensive fertility tests and treatments that are otherwise unaffordable to most individuals.
Reduces financial uncertainty for those pursuing IVF, IUI, egg/sperm preservation, or other assisted reproductive technologies.
Some plans now include counseling and mental health support for fertility-related concerns, promoting holistic care.
Where state mandates or employer group benefits apply, eligibility is more inclusive and cost-sharing may be more predictable.
Cons
Not universally available—many plans, especially individual or small group ones, do not cover infertility services.
Benefit limits are common; plans may cap the number of IVF cycles or total dollar amount covered.
Waiting periods, preauthorizations, and strict eligibility criteria may apply, complicating timely access.
Even with coverage, high copays/coinsurance, uncovered procedures, or medication exclusions can result in substantial out-of-pocket costs.
Coverage rules may exclude unmarried couples, LGBTQ+ applicants, or those seeking certain types of reproductive care.
Costs & How Pricing Works
Premium: Plans with infertility coverage typically have higher monthly premiums due to the high average cost of fertility treatments and broader coverage scope.
Deductible: Standard health plan deductibles apply before fertility coverage may begin. Some plans impose an additional or separate deductible for fertility services.
Copay/Coinsurance: Office visits, ultrasounds, procedures, lab tests, and medications may all have unique copays or coinsurance requirements, sometimes with higher tiers for specialist care and fertility drugs.
Out-of-Pocket Maximum: This limits total yearly in-network costs per person/family, but plan exclusions, benefit caps, or out-of-network care can leave some expenses outside this limit.
Network: Providers must usually be in-network and may be further limited to designated fertility centers for coverage to apply. Out-of-network care may be excluded or trigger balance billing risks.
State Laws: Some states mandate a minimum level of fertility coverage in group plans, affecting cost structures and coverage scope. Others permit full or partial exclusion.
Important
This content is for educational purposes only. It is not insurance, legal, or tax advice.
Policy terms, eligibility, and pricing vary by state and insurer; verify details on official sources.
Covered Services & Exclusions
Covered services may include: diagnostic testing for infertility, ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), fertility drugs, egg/sperm preservation, embryo storage, and counseling or support services.
Typical exclusions: coverage for surrogacy, donor egg/sperm/embryo cycles, experimental treatments, or procedures not deemed medically necessary. Some plans limit age eligibility or the number of cycles per lifetime.
Waiting periods may apply before coverage is effective, especially on new employer plans.
Certain lifestyle-related infertility, voluntary sterilization reversals, or treatments for non-medical infertility may be excluded.
Coverage of related complications (e.g., pregnancy, multiples) depends on the terms of your underlying health policy.
Claims, Denials & Appeals
After services are provided, you receive an Explanation of Benefits (EOB) detailing what was billed, allowed, and your responsibility.
If a claim is denied (e.g., a service deemed not medically necessary, prior authorization lacking, or benefit exhausted), you have the right to request an internal appeal from your insurer; timeframes and appeal methods vary by plan and state.
If an internal appeal is unsuccessful, you may be eligible for an independent external review. State insurance departments regulate these processes for fully insured plans, while federal rules govern others; timelines and additional requirements apply.
Escalate unresolved issues by contacting your state insurance department (official homepage) or, in certain cases, through federal ACA Marketplace consumer protections.
Alternatives & Comparisons
Personal savings and health savings accounts (HSAs): HSAs may be used for qualifying infertility expenses but are subject to IRS rules; verify current-year details on the IRS homepage (official).
Employer-sponsored benefits: Some employers offer fertility-specific coverage, “fertility benefit providers,” or reimbursement programs outside of traditional insurance (note: not standard nor guaranteed, and governance differs).
Short-term health policies or supplemental plans often exclude fertility treatment by default.
Financial assistance from fertility clinics, medication discount programs, and state or nonprofit grants may be available in select cases.
Adoption or foster care alternatives, though not an insurance solution, may be considered by those unable to access or afford fertility treatment.
Side-by-Side Comparison
Feature
Employer Group Plan
ACA Marketplace Plan
Self-funded/Short-term
Coverage Scope
Often includes broader fertility benefits (if state mandates or employer chooses to offer)
Limited; most do not cover infertility except in some state-specific markets
Rarely covers any infertility treatments
Typical Premium
sample set by employer; varies
sample based on age/region; varies
lower, but with minimal coverage
Deductible
sample; may have separate fertility deductible
sample; standard deductible applies, fertility usually excluded
sample; standard applies, fertility excluded
Exclusions
Surrogacy, experimental treatments, donor cycles sometimes
Infertility services commonly excluded
All fertility treatments typically excluded
Claims Process
Standard health insurance process, in-network required
Standard for covered services; fertility usually excluded
Few to no claims for infertility
Quotes & Cost Drivers
Coverage limits and deductibles for fertility procedures can impact premium, copay, and coinsurance levels.
Age, health status, plan type, and whether services are sought in-network influence final costs.
Employer size, state fertility coverage mandates, and plan funding method (fully insured vs self-funded) are major factors in determining if infertility coverage is included.
Policy term and payment mode—annual vs monthly—may also impact pricing and availability.
Coverage Optimizer Checklist
Identify essential fertility services for your circumstances—diagnosis, IUI, IVF, medication, preservation, etc.
Confirm plan documents for exclusions, cycle/dollar caps, and ineligible services; seek written confirmation of coverage before starting treatment.
Evaluate deductible and coinsurance levels vs anticipated out-of-pocket needs for fertility care.
Ask insurers or benefits administrators about waiting periods, prior authorization rules, and documentation needed for claims.
State Rules & Minimums
Several U.S. states mandate at least some fertility coverage for fully insured employer group health plans (examples: Massachusetts, Illinois, Connecticut, New York, New Jersey, Maryland, California). Each has unique definitions, minimum benefits, and limits.
Self-insured (ERISA) employer plans, federal plans, and individual/Marketplace plans are generally exempt from state mandates but may voluntarily include infertility coverage.
Which states require infertility insurance coverage?
States like Massachusetts, Illinois, Connecticut, New York, New Jersey, and Maryland currently require some group plans to offer certain fertility benefits.
Exact benefits and limits vary; coverage may not be mandated for individual or self-funded employer plans.
Does Marketplace health insurance include infertility coverage?
Most ACA Marketplace plans do not include infertility treatment as an essential health benefit.
Some state-based Marketplaces or regional plans may optionally add coverage; always check plan details during enrollment.
Are IVF and fertility medications usually covered?
Some employer plans, especially in states with mandates, may cover IVF and fertility drugs subject to approval, limits, and copays.
Many plans, especially individual and short-term, exclude IVF and related services; always check before enrolling.
Can I get infertility coverage after already starting treatment?
Coverage is generally limited to services received after your start date and meeting applicable waiting periods.
Expenses for care initiated before enrollment or services rendered prior to coverage are almost never retroactively reimbursed.
How can I confirm my plan’s infertility coverage?
Request a summary of benefits and coverage (SBC) from your insurer or HR/benefits department.
Call your plan administrator and ask about infertility testing, treatment, medication coverage, limitations, and exclusions in writing.
Frequently Asked Questions
Can I purchase standalone infertility insurance?
Standalone infertility insurance is rare in the United States; coverage is usually integrated in group health plans or select comprehensive policies.
Some supplemental fertility benefit providers partner with employers but generally do not sell individual plans.
Does insurance always cover the full cost of IVF?
No, insurance rarely covers the full cost of IVF—even in states with mandates, dollar or cycle caps, copays, and coinsurance typically apply.
What should I do if my claim for fertility treatment is denied?
File an internal appeal with your insurer, then seek an independent external review if needed.
Contact your state insurance department’s consumer services division if you need further help or clarification.
Are LGBTQ+ families or single parents eligible for fertility coverage?
Eligibility varies by plan and state; some plans have restrictions, though an increasing number now provide more inclusive coverage.
Where can I find official guidance on infertility insurance?
Infertility insurance is an evolving and often complex benefit. Coverage varies dramatically by plan, employer, and state, with restrictive eligibility and numerous exclusions possible.
Consumers should carefully review plan documents, ask for written confirmation, and understand all waiting periods, out-of-pocket maximums, and service caps before enrolling or starting treatment.
