What States Require IVF Insurance Coverage?

In Vitro Fertilization (IVF) offers hope to many individuals and couples facing infertility challenges. However, the financial implications of these advanced treatments can be substantial. Understanding IVF insurance coverage is a primary concern, as it determines accessibility to these complex and often costly procedures. This article explores state-level mandates shaping IVF insurance coverage across the United States.

Understanding State Mandates

A state mandate for IVF insurance coverage is a legislative requirement for health insurance plans to either cover or offer infertility treatments, including IVF. These mandates aim to expand access to fertility care by recognizing infertility as a medical condition. There are two main types of mandates: a “coverage mandate” requires insurers to include specific infertility treatments in standard health plans, while an “offer mandate” obligates insurers to make coverage available for purchase. These state-level requirements apply to state-regulated insurance plans, including many employer-sponsored and individual policies. However, self-funded employer plans are exempt from state mandates due to federal ERISA (Employee Retirement Income Security Act) regulations. The scope of these mandates reflects varying state perspectives on healthcare access and medical necessity for reproductive health services.

States with Mandated IVF Insurance Coverage

Many states have enacted mandates for infertility treatment coverage, including IVF. These mandates vary in scope, from comprehensive coverage to an offer of coverage, or focus on fertility preservation.

Comprehensive Coverage Mandates

States with comprehensive coverage mandates for IVF include Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, and Rhode Island.
Connecticut: Provides comprehensive fertility coverage, including IVF.
Delaware: Mandates fertility coverage, including up to six egg retrievals and unlimited embryo transfers.
Illinois: Requires group health insurance policies to cover infertility diagnosis and treatment, including IVF, for employers with 25 or more employees. A new law effective 2026 will remove prior caps on IVF cycles for all group plans.
Maryland: Requires coverage for IVF, with a limit of three IVF attempts per live birth, up to a $100,000 lifetime benefit.
Massachusetts: Has a broad coverage mandate for infertility treatments.
New Hampshire: Mandates fully-insured health plans cover infertility services, including up to four IVF cycles per lifetime.
New Jersey: Covers IVF with up to four egg retrievals per lifetime for eligible patients.
New York: Requires large group insurance providers to cover up to three cycles of IVF.
Rhode Island: Has robust mandates for infertility diagnosis and treatment, often including IVF.
Hawaii: Mandates coverage for one IVF cycle if specific criteria are met.
Arkansas: Mandates coverage for IVF in fully-insured plans.

Offer Mandates

Some states have “offer mandates,” where insurers must make infertility coverage available, but purchase is not required.
California: A new law effective 2026 will require large group health plans (100+ employees) to cover IVF services, including up to three egg retrievals and unlimited embryo transfers.
Texas: Has an offer mandate for infertility coverage.

Fertility Preservation Mandates

Other states focus mandates on fertility preservation.
Louisiana and Montana: Mandates primarily focus on fertility preservation for cancer patients.
Ohio and Utah: Require coverage for fertility preservation when medically necessary.

Key Elements of Mandated Coverage

State mandates for IVF insurance coverage outline specific services, limitations, and eligibility criteria. Covered services typically include diagnostic testing, fertility medications, and procedures like intrauterine insemination (IUI), in addition to IVF cycles. Some mandates also cover egg or sperm freezing for medical reasons, such as before cancer treatment.

Limitations often include age limits for individuals seeking treatment. For example, New Jersey’s mandate covers patients up to 45, while New York’s applies to those between 21 and 44. Mandates frequently impose a maximum number of covered IVF cycles, such as two or three, or a lifetime monetary maximum.

Eligibility criteria for coverage often depend on the definition of infertility, typically a period of unprotected intercourse without conception (e.g., one year for women under 35, six months for women 35 and older). Some mandates have broadened definitions to include LGBTQ+ individuals or single parents by choice. A medical diagnosis confirming infertility may be required, and certain conditions might preclude coverage.

Mandates often apply only to employers of a certain size, exempting smaller businesses. For instance, Illinois requires coverage for groups of more than 25 employees, while New York and California’s new law apply to large group plans of 100 or more employees. Self-insured plans are generally exempt from state mandates.

Options for Uncovered IVF Costs

For individuals in states without IVF insurance mandates, or when costs fall outside coverage, several financial strategies can help manage expenses. Many employers voluntarily offer fertility benefits; review specific plan documents.

Individual insurance policies generally offer limited comprehensive IVF coverage. Therefore, many explore financing options designed for fertility treatments. Medical loans from specialized lenders or payment plans from fertility clinics can help spread costs.

Various fertility grants and discount programs can also offset treatment costs. Non-profit organizations provide financial assistance through grants. Pharmaceutical companies may offer patient assistance programs to reduce medication costs. Utilizing tax-advantaged accounts like Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) can also help pay for eligible medical expenses with pre-tax dollars.