About 20 states have laws requiring insurance companies to cover or offer coverage for fertility treatments, and 15 of those specifically mandate coverage for in vitro fertilization (IVF). But living in one of these states doesn’t guarantee your plan will pay for IVF. The type of employer you work for, the size of the company, and the specific plan you carry all determine whether the mandate actually applies to you.
States That Mandate IVF Coverage
Fifteen states currently require insurance plans to cover IVF. These “mandate to cover” laws mean that qualifying health insurance policies sold in the state must include IVF as a benefit. The states with IVF-specific coverage mandates are:
- Arkansas
- Colorado
- Connecticut
- Delaware
- Illinois
- Louisiana
- Maine
- Maryland
- Massachusetts
- New Hampshire
- New Jersey
- New York
- Oregon
- Rhode Island
- Utah
Several additional states require coverage of broader fertility treatments or diagnostics without specifically naming IVF. Others, like Vermont, have a “mandate to offer,” which means insurers must make IVF coverage available as an option, but your employer doesn’t have to include it in the plan they purchase.
The distinction matters. Under a mandate to cover, the benefit is baked into your policy automatically. Under a mandate to offer, your employer can decline the coverage, and many do to keep premiums lower.
What These Mandates Typically Require
Each state writes its own rules, so the details vary significantly. Most states define infertility as the inability to conceive after 12 months of unprotected intercourse, though some shorten that window for women over 35. Coverage generally applies to women of reproductive age, roughly 19 to 45, though specific age cutoffs differ by state.
Illinois offers a useful example of how detailed these mandates get. The state requires coverage for up to four completed egg retrievals. If a live birth results from one of those cycles, coverage extends for up to two additional retrievals, bringing the lifetime maximum to six. Other states set dollar caps instead of cycle limits, or impose both.
Arkansas requires all individual and group insurance policies that include maternity benefits to cover IVF, but exempts HMOs entirely. Maryland caps the lifetime benefit and requires that less expensive treatments be tried first. Massachusetts is often considered one of the most comprehensive, with no lifetime dollar cap and coverage for medically necessary fertility treatments broadly.
Some states require that patients meet specific diagnostic criteria before IVF is covered. You may need a documented infertility diagnosis, evidence that you’ve attempted other treatments first, or proof that a medical condition (like blocked fallopian tubes) makes IVF the only viable option.
The Self-Insured Employer Gap
Here’s the catch that surprises most people: 65% of adults with employer-sponsored health insurance work for self-insured employers. These companies fund their own health plans rather than purchasing policies from insurance carriers, and they’re regulated under a federal law called ERISA, not state insurance law. That means state mandates don’t apply to them at all.
If you work for a large corporation, a hospital system, or a major university, your employer is likely self-insured. Even if you live in a state with a strong IVF mandate, your plan may offer zero fertility coverage. The mandate only reaches “fully insured” plans, which are more common among small and mid-sized employers that buy group policies from insurance companies.
This creates an uneven landscape. Two people in the same state, even the same city, can have completely different fertility benefits depending on how their employers structure their health plans. The only way to know for sure is to check your specific plan documents or call the number on your insurance card.
Other Common Exemptions
Beyond the self-insured gap, several states carve out additional exemptions. Religious employers can often opt out of fertility coverage mandates. Some states exempt small businesses below a certain employee threshold. Others exclude government employee plans or specific plan types like HMOs.
Arkansas, for instance, exempts HMOs from its IVF mandate entirely. Vermont excludes both self-insured plans and religious employers. These exemptions can be stacked, meaning that in some states, the mandate technically exists but reaches a relatively small share of the insured population.
States Without IVF Mandates
If you live in one of the roughly 30 states without an IVF mandate, your coverage depends entirely on what your employer or individual plan offers. Some large employers voluntarily cover IVF as a recruitment and retention tool, particularly in tech, finance, and healthcare. Others offer no fertility benefits at all.
Without a mandate, you’re looking at out-of-pocket costs that typically range from $15,000 to $30,000 per IVF cycle, including medications. Many people in non-mandate states pursue options like fertility-specific financing programs, grants from nonprofit organizations, or plans purchased through a spouse’s employer in a mandate state.
How to Check Your Coverage
Start with your Summary of Benefits and Coverage (SBC), the standardized document your insurer provides. Look for sections on fertility, infertility, or reproductive services. If the language is vague, call your insurance company directly and ask specifically about IVF, including how many cycles are covered, whether there’s a lifetime dollar cap, and what diagnostic steps are required before coverage kicks in.
If your current plan doesn’t cover IVF, check whether your state has a mandate to offer. If it does, you may be able to request that your employer add fertility coverage during the next plan renewal. RESOLVE, the National Infertility Association, maintains a state-by-state breakdown of current laws that can help you understand exactly what your state requires and how to advocate for coverage through your employer.