Whether your insurance covers IVF depends on your plan type and your state, not on a single national rule

Insurance coverage for in vitro fertilization (IVF) varies dramatically. Some plans cover it fully. Some cover only diagnostic testing. Some cover nothing at all. Your coverage depends on three things: what your specific plan says, what state you live in, and whether your employer or union negotiated fertility benefits into your contract. There is no federal requirement that insurance cover IVF, so you cannot assume it does.

The fastest way to know what you have is to call your insurance company's member services line — the number is on your insurance card — and ask directly: "Does my plan cover in vitro fertilization, and if so, what are the limits?" Write down the name of the person you spoke to and the date. Then ask them to send you the answer in writing, because verbal answers sometimes contradict what the written policy says when you try to use it.

Key Takeaways

  • Your insurance company's member services line can tell you in one call whether your specific plan covers IVF, what percentage it pays, and what documentation your fertility clinic will need to submit.
  • Thirteen states have laws requiring insurance to cover some or all of IVF, but the rules differ by state — some cover only certain diagnoses, some only certain ages, and some only after failed attempts at other treatments.
  • If your plan does not cover IVF, you can ask your employer's benefits department whether they will negotiate coverage, or explore whether you may have access to for a state-mandated plan if you live in a state with an IVF coverage law.
  • Your fertility clinic's financial counselor can often tell you which insurance plans they see cover IVF most completely, and can help you understand what your plan will and will not pay for before you start treatment.
  • Some employers offer fertility benefits through third-party administrators separate from medical insurance, so ask your benefits department whether your workplace has a separate fertility or family-building program.

How to find out what your plan covers right now

Call the member services number on your insurance card. Have your policy number ready. Ask: "Does my plan cover in vitro fertilization?" and "If yes, what percentage does it cover and what are the limits?" Some plans cover 50 percent, some cover 80 percent, and some cover 100 percent. Some plans cover only one cycle, some cover up to three, and some have no cycle limit. Some plans cover only the procedure itself and not the medications, which can cost $3,000 to $7,000 per cycle.

Ask also whether your plan requires prior authorization — a form your fertility clinic must submit before treatment starts, proving the treatment is medically necessary. Most plans that cover IVF do require this. Ask whether your plan covers diagnostic testing (blood work, ultrasounds, genetic testing) and whether it covers freezing and storing embryos. Write down everything they tell you and ask them to mail or email you a summary.

Then call your fertility clinic's financial counselor or billing department. Give them your insurance information and ask them to verify your coverage with your insurance company directly. Clinics do this routinely and often catch details that member services representatives miss. The clinic can also tell you whether your insurance plan is one they work with frequently and whether they know of common issues with that plan.

State laws that require insurance to cover IVF

Thirteen states have passed laws requiring insurance plans to cover some or all of IVF: Arkansas, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Ohio, Rhode Island, and Texas. However, the rules are not the same in each state. Some states cover only certain diagnoses (for example, blocked fallopian tubes but not low sperm count). Some states cover only people under a certain age. Some states require you to have tried other treatments first. Some states cover only the procedure and not the medications.

If you live in one of these states, your insurance company is required by state law to tell you what coverage you have. Call member services and say: "I live in [state name] and I want to know what coverage your plan provides under [state name]'s IVF coverage law." If they say your plan does not cover IVF, ask them to explain which part of the state law your plan is exempt from — some plans are exempt because they are self-insured by a large employer, or because they are religious plans, or for other reasons. Ask them to send you the exemption in writing.

If your plan claims an exemption you do not understand, contact your state's insurance commissioner's office. Each state has one, and they investigate complaints about insurance coverage. You can find your state insurance commissioner through the National Association of Insurance Commissioners website.

What to do if your plan does not cover IVF

If your plan does not cover IVF, you have several options. First, ask your employer's benefits department whether they will consider adding fertility coverage to the plan. Some employers add benefits when employees request them, especially if multiple people ask. Bring information about the cost — fertility coverage typically adds $1 to $3 per employee per month to premiums — and information about how many employees might use it.

Second, if you live in a state with an IVF coverage law, ask your benefits department whether you can switch to a plan that does cover IVF. Some employers offer multiple plan options, and at least one may be subject to the state law. If you are on a plan through your spouse's employer, ask whether their employer offers a plan with fertility coverage.

Third, ask your fertility clinic whether they offer payment plans or financing options. Many clinics work with medical financing companies that let you pay for treatment over time. Some clinics also offer discounts for paying in full upfront, or discounts for multiple cycles. Some offer shared-risk programs where you pay a flat fee upfront for up to three cycles, and if none result in a live birth, you get most of your money back.

How prior authorization works and what your clinic needs

If your plan covers IVF and requires prior authorization, your fertility clinic will handle most of the paperwork. Before your first appointment, give the clinic your insurance information. They will submit a form to your insurance company that includes your diagnosis (for example, "infertility due to diminished ovarian reserve"), your age, your treatment plan, and sometimes your medical history. The insurance company reviews this and decides whether to approve the treatment.

Prior authorization usually takes one to two weeks. Your clinic will tell you when it is approved. If it is denied, your clinic can appeal — they will submit additional information explaining why the treatment is medically necessary. Appeals can take another two to four weeks. This is why it is important to start the authorization process as soon as you decide to pursue IVF, not the week before you want to start medications.

Some plans require prior authorization for each cycle of IVF. Some require it only for the first cycle. Ask your insurance company whether you need new authorization for each cycle, or whether one authorization covers multiple cycles.

Understanding what your plan will and will not pay for

IVF involves several separate costs, and insurance plans often cover some but not others. The procedure itself — egg retrieval, fertilization, and embryo transfer — is usually what is covered. Medications (hormones to stimulate the ovaries) are sometimes covered and sometimes not. Genetic testing of embryos (called PGT or preimplantation genetic testing) is sometimes covered and sometimes not. Freezing and storing embryos is sometimes covered and sometimes not. Ultrasounds and blood work are usually covered if they are done at your regular doctor's office, but sometimes not if they are done at the fertility clinic.

Ask your insurance company specifically about each of these. Write down what is covered and what is not. Then ask your fertility clinic to give you an estimate of the total cost, broken down by what your insurance will pay and what you will owe. Do not start treatment without this estimate in writing.

What happens if your insurance denies coverage

If your insurance company denies coverage for IVF, you have the right to appeal. Your fertility clinic can help you with this. Ask them to submit an appeal letter explaining why the treatment is medically necessary for your specific situation. Insurance companies must respond to appeals within a certain timeframe — usually 30 days for standard appeals and 72 hours for urgent appeals.

If the appeal is denied, you can file a complaint with your state's insurance commissioner. You can also ask your state representative or senator for help — many legislators' offices have staff who work on constituent complaints about insurance. If you live in a state with an IVF coverage law and your plan is denying coverage that the law requires, contact your state insurance commissioner when ready.

Fertility benefits through your employer that are separate from medical insurance

Some employers offer fertility benefits through a separate program, not through the medical insurance plan. These programs are sometimes called family-building benefits or fertility benefits. They may cover IVF even if your medical insurance does not. Ask your benefits department whether your employer offers a separate fertility program. If they do, ask what it covers and how to enroll.

Some employers also offer flexible spending accounts (FSAs) or health savings accounts (HSAs) that let you set aside pre-tax money to pay for medical expenses, including fertility treatment and medications. If your plan does not cover IVF, you can use money from an FSA or HSA to pay for it without paying income tax on that money. Ask your benefits department whether your employer offers these accounts and whether fertility treatment is a covered expense.

Frequently Asked Questions

Can I use my HSA or FSA to pay for IVF if my insurance does not cover it?

Yes. Both HSAs and FSAs allow you to pay for fertility treatment and medications with pre-tax money, which reduces your overall cost. You can set aside money from your paycheck before taxes are taken out, then use that money to pay your fertility clinic or pharmacy. Ask your benefits department how much you can set aside per year — the limits change annually.

If I switch jobs, will my new insurance cover IVF?

It depends on the new plan. Some plans cover IVF and some do not. Before you switch jobs, ask the new employer's benefits department what fertility coverage their plans offer. If you are in the middle of IVF treatment, ask whether the new plan will cover ongoing cycles or whether you will have to start over with a new authorization process.

Does my plan have to cover IVF if I live in a state with an IVF coverage law?

Not necessarily. Some plans are exempt from state laws because they are self-insured by large employers, or because they are religious plans, or for other reasons. Ask your insurance company whether your plan is subject to your state's IVF coverage law. If they say it is exempt, ask them to explain the exemption in writing.

What if my fertility clinic is out of network?

If your plan covers IVF, it usually covers it only at in-network clinics, or covers it at a lower percentage if you go out of network. Ask your insurance company which fertility clinics are in network before you choose a clinic. If you have already chosen a clinic that is out of network, ask your insurance company whether they will make an exception and cover it as in-network.

Can I get my money back if IVF does not work?

Insurance does not refund money for unsuccessful treatment. However, some fertility clinics offer shared-risk or refund programs where you pay a flat fee upfront for multiple cycles, and if none result in a live birth, you get most of your money back. Ask your clinic whether they offer this option.