Does Medicare Cover Fertility Treatments?

Medicare, the federal health insurance program, primarily serves individuals aged 65 or older, along with younger people who have certain disabilities or End-Stage Renal Disease. A common question concerns Medicare’s coverage for fertility treatments. This article clarifies Medicare’s general stance on fertility services and explores alternative funding options for these often costly procedures.

Medicare’s Policy on Fertility Treatments

Medicare generally does not cover direct fertility treatments, such as In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), or gamete cryopreservation for non-medical reasons. These procedures are typically considered elective or not medically necessary for overall health, which falls outside Medicare’s primary scope of covering services to diagnose or treat illness or injury.

Medicare Part A, which covers hospital insurance, would not typically apply to direct fertility procedures performed in an outpatient setting. However, if a fertility-related issue necessitates an inpatient hospital stay, Part A might cover the hospital costs, subject to deductibles and coinsurance, assuming the stay is for a Medicare-covered medical condition. For example, if a severe ovarian hyperstimulation syndrome (OHSS) from fertility medication required hospitalization, Part A could apply.

Medicare Part B covers medically necessary doctors’ services, outpatient care, medical supplies, and preventive services. While it may cover some diagnostic tests to determine the cause of infertility, it generally excludes direct fertility treatments like IVF. For services that are covered, beneficiaries are responsible for the Part B annual deductible, which is $257 in 2025, and then typically a 20% coinsurance of the Medicare-approved amount. Medicare Advantage plans (Part C), which are offered by private companies approved by Medicare, must cover everything Original Medicare (Parts A and B) covers, but they may have different costs and additional benefits, requiring beneficiaries to check with their specific plan.

Medicare Part D, which provides prescription drug coverage, generally does not cover medications specifically used for fertility treatments. Most Part D plans exclude fertility drugs from their formularies, meaning beneficiaries would pay 100% of the cost for these prescriptions out-of-pocket. This broad exclusion applies even if a physician prescribes these medications as part of a fertility treatment plan.

Related Medical Services Covered by Medicare

While direct fertility treatments are largely excluded, Medicare may cover diagnostic tests and treatments for underlying medical conditions that cause infertility, provided these are medically necessary for the patient’s general health. This includes services to diagnose the root cause of infertility, such as blood tests to check hormone levels, ultrasounds to examine reproductive organs, or genetic testing. For instance, a sperm analysis to diagnose male infertility may be covered if deemed medically essential by a physician.

Medicare Part B can cover treatments for conditions like endometriosis, Polycystic Ovary Syndrome (PCOS), or fibroids, even if these conditions also contribute to infertility. For example, surgical procedures to remove fibroids or treat endometriosis would typically be covered if necessary to alleviate pain or other health complications, irrespective of their impact on fertility. Diagnostic imaging like CAT scans or MRI scans ordered to investigate an underlying medical issue are also generally covered.

The crucial distinction lies between treating a medical condition for overall health and directly funding procedures aimed solely at achieving conception. For example, if a thyroid disorder is causing infertility, Medicare would cover the diagnosis and treatment of the thyroid condition itself. However, it would not cover the subsequent IVF cycle that might be pursued to achieve pregnancy, even if the thyroid condition’s treatment improved fertility prospects.

Understanding Other Insurance and Financial Options

Given Medicare’s limited coverage for direct fertility treatments, individuals often explore private health insurance plans and other financial resources. Private health insurance, including employer-sponsored plans and those purchased individually, can offer varying levels of fertility coverage. Many states have enacted “mandate to cover” laws, requiring certain insurers to provide some level of fertility treatment coverage, though the scope of these mandates differs widely. These state mandates may specify covered treatments, such as IVF or IUI, impose age limits, or include monetary caps on coverage, and typically apply only to fully-insured plans, not self-funded employer plans.

Beyond insurance, several financial assistance programs and grants exist to help offset the substantial costs of fertility treatments, which can easily exceed $10,000 for a single cycle of IVF. Non-profit organizations like the Tinina Q. Cade Foundation and Baby Quest Foundation offer grants, often ranging from a few thousand dollars up to $10,000 or more, to eligible individuals and couples. Eligibility for these grants often depends on factors such as a medical diagnosis of infertility, U.S. residency, and financial need, sometimes requiring application fees.

Specialized financing programs, such as those offered by CapexMD or Lending Club Patient Solutions, provide loans specifically for fertility treatments, including medical procedures, medications, and related expenses. These loans can range from $5,000 to $100,000, with varying interest rates and repayment terms. Additionally, pharmaceutical companies offer patient assistance and discount programs for fertility medications, such as EMD Serono’s Compassionate Care Program or ReUnite Assist. These programs may provide discounts of 25% to 75% or even free medications based on income, military status, or other specific criteria.