What States Require Insurance To Cover Ivf Treatment?

Infertility affects about 1 in 8 couples in the United States, yet the cost of a single in vitro fertilization (IVF) cycle often exceeds $15,000. For many, health insurance is the deciding factor between pursuing treatment and stopping. Currently, 21 states have laws requiring some form of insurance coverage for fertility treatment, but only a handful mandate coverage for IVF specifically. The rest leave coverage decisions entirely to employers and insurers, which is why your zip code and your employer can determine whether you have access to this treatment at all.

Which States Currently Require Insurance To Cover IVF?

As of recent legislative sessions, 21 states have fertility insurance laws on the books. However, the term “coverage” means different things in different states. Some states only require insurers to offer coverage, meaning they must present a policy that includes IVF, but employers can decline it. Other states mandate coverage, meaning specific insurance plans must include IVF benefits.

The states that require insurance plans to cover IVF treatment include:

• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Illinois
• Louisiana
• Maine
• Maryland
• Massachusetts
• Montana
• New Hampshire
• New Jersey
• New York
• Ohio
• Rhode Island
• Texas
• Utah
• West Virginia

This list changes as new laws pass. It is important to check your state’s current insurance regulations, as legislative updates happen regularly. Some states on this list have significant limits on who qualifies, so having a law on the books does not guarantee that you personally are covered.

What Is the Difference Between Mandated Coverage and Mandated Offer?

This distinction matters more than any other detail in fertility insurance law. A mandated offer state requires insurance companies to sell a policy that includes IVF coverage, but employers are not required to buy it. If your employer chooses a cheaper plan without fertility benefits, you have no coverage.

A mandated coverage state requires that all insurance plans regulated by the state include IVF benefits. Massachusetts, Illinois, and New Jersey are examples of states with strong mandated coverage laws. In these states, most fully insured employer plans must include IVF.

There is a third category: states that require coverage for fertility preservation but not for IVF itself. These laws typically apply to people undergoing medical treatments that may harm fertility, such as chemotherapy. They do not help the average couple seeking IVF for infertility.

Which States Have the Most Comprehensive IVF Coverage Laws?

Massachusetts is widely considered to have the most comprehensive IVF coverage mandate in the country. The law requires coverage for up to six completed IVF cycles, which is more generous than any other state. It also covers diagnostic testing and other fertility treatments.

Illinois requires coverage for up to four cycles of IVF. New Jersey mandates up to four completed cycles as well. These two states, along with Massachusetts, are the most generous in terms of the number of cycles covered.

Rhode Island requires one cycle of IVF coverage. Connecticut requires coverage for IVF, but the law applies only to plans with more than 50 employees. New York’s mandate, which took effect in 2020, covers up to three cycles of IVF but has strict eligibility requirements.

Some states, like California and Texas, have laws that require insurers to offer coverage but do not require employers to purchase it. In practice, this means many people in those states have no IVF coverage at all.

What Are the Eligibility Requirements for State-Mandated IVF Coverage?

State mandates are not automatic. Every state with an IVF coverage law imposes conditions you must meet before insurance will pay. The most common requirements include:

• You must have a documented diagnosis of infertility, usually defined as one year of unprotected intercourse without conception (or six months if you are over age 35)
• You must use your own eggs and sperm in most cases, though some states have updated laws to include other family-building paths
• You must have tried less expensive treatments first, such as oral ovulation induction medications with timed intercourse or intrauterine insemination (IUI)
• You must be under a maximum age, often between 42 and 45
• You must not have had a prior sterilization procedure, such as a tubal ligation or vasectomy

These requirements vary significantly by state. Massachusetts, for example, does not require prior treatment attempts. Other states require documented attempts at IUI before covering IVF. Some states exclude coverage if you have frozen embryos from a previous cycle.

Age limits are a major barrier for many people. Most mandates do not apply to women over age 42 or 44, even though IVF success rates at those ages are lower and the treatment is often medically necessary.

Does the IVF Mandate Apply to Your Insurance Plan?

This is the most confusing part of fertility insurance law. State mandates apply only to fully insured plans purchased within that state. They do not apply to self-funded plans, which are plans where the employer pays medical claims directly and uses an insurance company only to administer the plan.

Roughly 60% of Americans with employer-sponsored health insurance are in self-funded plans. If your employer is self-funded, your state’s IVF mandate does not apply to you at all. Your coverage depends entirely on what your employer decides to include in the plan.

This is why two people working for different companies in the same state can have completely different fertility coverage. One may have full IVF coverage, and the other may have none, even though both plans are regulated by the same state.

You can find out if your plan is self-funded by checking your insurance card or calling the customer service number. The plan document, called a Summary Plan Description, will also state whether the plan is self-funded or fully insured.

What About Insurance Plans Purchased Through the Affordable Care Act Marketplace?

Plans sold on the Affordable Care Act (ACA) marketplace are not required to cover IVF. The ACA does not list fertility treatment as one of the ten essential health benefits that all plans must cover. Some marketplace plans offer limited fertility coverage, but this varies by state and by insurer.

Some states have passed laws requiring marketplace plans to cover fertility treatment. For example, Colorado and New Hampshire have added fertility coverage requirements for marketplace plans sold in their states. But in most states, an ACA marketplace plan will not include IVF coverage.

Medicaid, the state-federal program for low-income individuals, does not cover IVF in any state. Some states cover diagnostic fertility testing or oral medications, but IVF is excluded from Medicaid coverage nationwide.

How Do Employer Decisions Affect IVF Coverage More Than State Laws?

The reality is that your employer’s decision matters more than your state’s law in most cases. Large employers like Starbucks, Amazon, and Google have added IVF coverage to their benefits packages voluntarily. These companies often provide coverage to employees in all states, regardless of state mandates.

If you work for a small or mid-sized employer, your coverage is much less predictable. Small employers are more likely to be fully insured, meaning state mandates apply. But they are also less likely to choose plans with generous fertility benefits because of the cost.

Employers who self-fund are not bound by state mandates, but they are also free to add IVF coverage voluntarily. Many large employers do this because fertility benefits help with recruitment and retention. The decision is purely financial, not regulatory.

If you are job hunting and IVF coverage is important to you, you should ask about fertility benefits during the interview process. This is a legitimate question about compensation and benefits, and employers expect it.