The Affordable Care Act does not require health insurance plans to cover IVF. There is no federal mandate for fertility treatment of any kind under the ACA’s essential health benefits. Whether your Marketplace plan, employer plan, or any other ACA-compliant plan covers IVF depends almost entirely on which state you live in and what type of plan you have.
Why the ACA Doesn’t Mandate IVF Coverage
The ACA established 10 categories of essential health benefits that all individual and small-group plans must cover, including maternity care, prescription drugs, and preventive services. Infertility treatment is not one of them. Congress left fertility services out of the federal requirements, which means insurers can legally exclude IVF from any plan sold on the Marketplace or through an employer.
What fills that gap, in some places, is state law. Individual states can add their own benefit mandates on top of the federal requirements. About a dozen states now require at least some insurers to cover IVF, but the details vary dramatically. If your state hasn’t passed a fertility mandate, your Marketplace plan almost certainly excludes IVF, and there’s nothing in the ACA that overrides that exclusion.
States That Require IVF Coverage
The following states have laws requiring certain health insurers to cover IVF, though the scope and limits differ in each:
- Arkansas: All individual and group policies with maternity benefits must cover IVF. HMOs are exempt.
- California: Large group plans (100+ employees) must cover IVF. Small group plans must cover other infertility treatments but can exclude IVF.
- Connecticut: Covers up to 2 lifetime cycles of IVF, with no more than 2 embryo transfers per cycle.
- Delaware: All individual, group, and blanket policies must cover IVF, including IVF with donor eggs, donor sperm, or gestational carriers.
- Hawaii: One cycle of IVF.
- Illinois: Group insurers and HMOs providing pregnancy coverage must cover IVF along with other fertility treatments.
- Maryland: Plans with pregnancy benefits must cover up to 3 IVF cycles per live birth.
- Massachusetts: All insurers providing pregnancy benefits must cover IVF, along with egg freezing, sperm banking, and related procedures.
- New Jersey: Group insurers, HMOs, and state employee plans must cover IVF, including IVF with donor eggs or gestational carriers.
- New York: Large group plans (100+ employees) cover up to 3 IVF cycles. Individual and small group plans are excluded.
Notice the pattern: several states limit coverage to large group employer plans or to plans that already include maternity benefits. If you’re buying an individual Marketplace plan, even in a mandate state, you may not be covered. New York, for example, explicitly excludes IVF from its individual and small group markets. California’s mandate only applies to large employers. These distinctions matter, and the only way to know for sure is to read the Summary of Benefits and Coverage for your specific plan.
Large Group vs. Small Group vs. Individual Plans
State mandates typically apply to “fully insured” plans, meaning the insurance company bears the financial risk. Most small businesses and individual Marketplace shoppers have fully insured plans, so state mandates can apply to them. Large employers, however, often “self-fund” their health plans, meaning the company pays claims directly and only uses an insurer to administer them. Self-funded plans are regulated under federal law (ERISA), not state law, so state fertility mandates generally don’t apply to them.
This creates an ironic situation: the states that mandate IVF coverage for large group plans can only enforce those mandates on the subset of large employers that buy fully insured products. A Fortune 500 company with a self-funded plan can choose to cover IVF or not, regardless of state law. Many large tech companies and financial firms do offer fertility benefits voluntarily, but it’s an employer-by-employer decision.
What Insurers Typically Require
Even when a plan covers IVF, you’ll need to meet specific medical criteria before the insurer approves it. The requirements follow a general pattern across most carriers. If you’re under 35, you typically need to show 12 months of trying to conceive naturally, or 4 cycles of medically assisted insemination. If you’re 35 or older, the threshold drops to 6 months of trying or 3 cycles of insemination.
Most plans exclude coverage if infertility resulted from a previous voluntary sterilization, such as a tubal ligation or vasectomy, even if that procedure was later reversed. Some insurers also set age-based hormone level thresholds for women using their own eggs. Prior authorization is almost always required, meaning your fertility clinic will need to submit documentation before treatment begins.
What IVF Costs Without Coverage
A single conventional IVF cycle runs between $9,000 and $19,000 for fresh eggs and $8,000 to $17,000 for frozen eggs. That price covers the core procedure but not the injectable hormone medications (averaging about $4,000 per cycle), anesthesia, genetic testing of embryos, or additional frozen embryo transfers. When you add everything up, a single complete cycle often lands between $15,000 and $25,000. Most people need more than one cycle to achieve a pregnancy, which is why lifetime costs can reach $50,000 or more.
If your plan doesn’t cover IVF, you still have some options for reducing the out-of-pocket cost. Diagnostic testing for infertility, such as bloodwork, ultrasounds, and semen analysis, is more commonly covered than treatment itself, even on plans that exclude IVF. Getting the diagnostic workup covered can save several thousand dollars in the early stages.
Using HSA or FSA Funds for IVF
IVF and related fertility treatments are considered qualified medical expenses by the IRS, which means you can use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for them with pre-tax dollars. This effectively gives you a discount equal to your marginal tax rate, often 22% to 32% for middle-income households. The limitation is contribution caps: HSAs max out at $4,300 for individual coverage in 2025 ($8,550 for family coverage), so you can’t fund an entire IVF cycle in a single year through an HSA alone. Some people contribute the maximum over two or three years before starting treatment to build up a balance.
Federal Employee Plans as a Special Case
Federal employees have seen a notable expansion in IVF access. For 2025, 25 Federal Employees Health Benefits (FEHB) plans across 45 options now cover IVF services, with 7 of those plans added for the first time this year. All FEHB carriers are required to cover three cycles of IVF-related medications, even if the plan doesn’t cover the procedure itself.
Coverage limits among FEHB plans vary widely. Some plans cover IVF with no cycle or dollar limit. Others cap coverage at 3 cycles per live birth or set annual dollar limits ranging from $5,000 to $50,000. CareFirst BlueChoice, for example, covers 3 cycles per live birth with a $45,000 annual cap. Kaiser plans in Colorado and the mid-Atlantic region cap coverage at 3 attempts per pregnancy with a $50,000 annual maximum. If you’re a federal employee, the plan comparison documents from OPM spell out exactly what each option covers.
How to Check Your Specific Plan
The most reliable way to find out whether your plan covers IVF is to pull up its Summary of Benefits and Coverage document and search for “infertility,” “fertility,” or “assisted reproductive.” Marketplace plans post this document on HealthCare.gov or your state exchange before you enroll. Look specifically in the “exclusions” section, because many plans that cover diagnostic testing still exclude IVF and other advanced reproductive technologies by name.
If you’re shopping for a new plan and IVF coverage matters to you, call the insurer directly and ask for the specific exclusion language. Plans in mandate states are required to comply with state law, but how they interpret limits on cycles, dollar caps, and eligible diagnoses varies. Getting a clear answer before you enroll is far easier than appealing a denial after treatment has started.