IVF Coverage in the US: Breaking Down the Laws, and What Patients Need to Know

In-vitro fertilization (IVF) and other assisted reproductive technologies (ART) are some of the most time-sensitive medical treatments. Every month matters, and delays caused by cost or lack of coverage can directly impact patient outcomes. Yet, figuring out what’s covered, and what isn’t, can feel confusing, overwhelming, and at times discouraging. 

At pregnantish, we believe in real talk about fertility (it’s in our tag line, after all!). When it comes to timing and trying to conceive we know that sometimes it’s healthy to step back and take a break, but we also recognize the reality that time can be a precious resource when pursuing steps like IVF or freezing your eggs.

As Dr. Nicole Ulrich, Reproductive Endocrinologist & Director of Advocacy at The Fertility Institute explains, “One of the biggest challenges (I see) is the lack of understanding of women’s bodies and reproductive health. People don’t always know what’s normal, what’s not, when fertility peaks, or how age impacts egg quality. I see women in their 40s who assume one IUI will result in pregnancy, not realizing how age affects ovarian reserve. On the other end, women in their early 30s panic about turning 35, thinking they won’t be able to conceive afterward. These misconceptions aren’t their fault—it’s a system failure.”

I see women in their 40s who assume one IUI will result in pregnancy, not realizing how age affects ovarian reserve. On the other end, women in their early 30s panic about turning 35, thinking they won’t be able to conceive afterward. These misconceptions aren’t their fault—it’s a system failure.”Though we’ve seen meaningful progress in recent years as more states pass fertility coverage mandates and employers expand benefits, gaps still remain, and misconceptions about reproductive health persist. Here’s a brief breakdown of what you need to know about recent laws, costs, and coverage around IVF in 2025.

The Current Landscape of IVF Coverage in the US

When it comes to fertility care in the United States, access to IVF coverage remains inconsistent and complex. 

At the federal level, there is no national guarantee of infertility treatment under the Affordable Care Act (also known as Obamacare). Infertility is still not considered an “essential health benefit” – this means that the power lies within states and employers to decide whether and how to cover IVF. The result is a patchwork of state coverage that leaves patients with vastly different options depending on where they live.

For example, in New York and Pennsylvania – two neighboring states who share a border of over 225 miles – the legislation could not be more different. In New York, state law requires large-group insurance plans to cover up to three full cycles of IVF and prohibits age-based exclusions, with additional protections for fertility preservation. By contrast, in Pennsylvania, there is no IVF coverage mandate, meaning benefits are left entirely to employers or individual plans. 

The result? Someone in New York City may have guaranteed access to multiple IVF cycles through insurance, while someone in Philadelphia may have to pay entirely out-of-pocket for the same care.

Infertility is still not considered an “essential health benefit” – this means that the power lies within states and employers to decide whether and how to cover IVF. According to RESOLVE: the National Infertility Association, as of April 2025, 22 states plus Washington, DC have passed insurance coverage legislation – 15 of those states include IVF coverage, and 20 states have fertility preservation laws for medically-induced infertility. That means that 28 states do not currently have laws in place to cover IVF or assisted reproductive technologies. 

Given the varied nature of coverage in the United States, and that every insurance coverage policy is different (some policies from the same insurer may even differ from employer to employer!), it’s crucial for patients to understand their particular plan, inclusions and exclusions, and covered benefits. 

Legislative Progress: A Mix of Strides and Gaps

In recent years, federal programs have taken important steps forward in expanding fertility coverage. 

• The Federal Employee Health Benefits (FEHB) program now requires all plans to cover three cycles of IVF-related medications, with some going further by offering IVF services themselves. 
• In 2024, the Veterans Health Administration also broadened its eligibility to include unmarried and same-sex veterans, as well as the use of donor gametes—though benefits remain limited to cases of military service-connected infertility. Though imperfect, these changes mark meaningful progress, particularly for marginalized communities that have long faced barriers to reproductive healthcare.

And yet, large gaps in access persist. 

• TRICARE, which provides health benefits to active-duty military and their families at the federal level, still excludes IVF in most circumstances. 
• Medicaid coverage is inconsistent across states and typically does not include IVF at all. 
• Even in states with fertility mandates, restrictions are common: insurers often impose cycle caps, dollar limits, or step-therapy requirements such as requiring patients to attempt IUI before accessing IVF. Coverage for donor gametes, surrogacy, and elective egg freezing is frequently absent, and self-funded employer health plans—governed by The Employee Retirement Income Security Act of 1974 (ERISA)—are exempt from state mandates altogether. One exception to this patchwork is fertility preservation for patients undergoing medical treatments like chemotherapy, which has seen broader acceptance and coverage.

This uneven progress underscores the complexities of policy change in reproductive health. 

Adding IVF to state marketplace benefits often raises budget concerns amongst our representatives, ERISA limits state influence over large employers, and ongoing political debates around reproductive rights further complicate momentum. 

For patients, the end result can be a confusing and inequitable system in which access, affordability, and coverage vary dramatically depending on a zip code or an employer’s benefit design.

A Clinical Perspective: The Reality of Waiting

Reproductive Endocrinologist Dr. Nicole Ulrich leads advocacy efforts at the Fertility Institute, part of the First Fertility network. Bringing both clinical insight and patient perspective, she shares her take on the pregnantish podcast, supported by First Fertility. Bottom line: she conveys that there is a real cost to waiting.

“As women move into their late 30s, ovarian reserve and egg quality decline. If patients delay treatment — whether because care isn’t accessible or because they’re waiting for promised legislation or coverage — they may reach a point where having genetically related children is no longer possible.

If patients delay treatment — whether because care isn’t accessible or because they’re waiting for promised legislation or coverage — they may reach a point where having genetically related children is no longer possible.I’ve heard patients say, ‘I’ll wait until universal coverage kicks in.’ But even if new laws passed tomorrow, implementation could take years. In Louisiana, we passed oncofertility coverage two or three years ago, and not all insurers have implemented it yet. Waiting for systemic change when you’re trying to build your family just isn’t realistic.

If you’re planning to delay family-building, talk with a specialist early, just to get a sense of where you stand. It’s never a bad idea to have more information. And if you’ve been trying and it’s not working — even if you’ve been told to ‘just keep trying’ — get another opinion from a fertility specialist. Knowledge is power, and waiting too long can make things more difficult.”

Should We Be Waiting For The White House?

Danielle Melfi, experienced leader and advocate advancing policy changes at both the state and federal levels, recently stepped into the role as CEO of RESOLVE. Melfi weighs in:

“This is an incredibly exciting time to join the family building community. More people than ever support IVF (recent polling suggests over 85%) and that’s because everyone knows someone that’s been impacted by infertility. This wide support is the foundation for bipartisan policy action to expand access to family building coverage. This support is also why the White House announced that they are looking at ways to expand access and reduce out-of-pocket costs. At RESOLVE, we’re also excited for California to implement its insurance mandate in 2026 – the largest state to do so. 

While the White House announced their commitment to expand access to IVF, we’re still waiting for action – and families are waiting too. As we look to states, we anticipate seeing ‘personhood bills’ (bills that define an embryo as a person and therefore restrict the practice of IVF in a state) continue to pop up. State governments are navigating how federal budget changes will impact their state budgets, and potential budget shortfalls could impact a state’s ability to expand IVF insurance coverage. 

The most important thing I want patients to hear is that they should not delay care in hopes of a new law — progress takes time, and access today depends on navigating existing options.The most important thing I want patients to hear is that they should not delay care in hopes of a new law — progress takes time, and access today depends on navigating existing options. We also understand that not everyone has that luxury as they can’t afford the out-of-pocket costs that come with a treatment like IVF if their insurance doesn’t cover it.

I’m immensely hopeful because the conversation around women’s health and infertility is changing every day – for the better. Women’s health and the challenges all types of families face in building their families are no longer hidden or dismissed. Together, patients, advocates, and allies are turning awareness into action and action into meaningful change.”

What People Who Want To Access Fertility Treatments Can Do Now

At pregnantish, we often encourage people to take breaks when they need them – fertility treatments can be exhausting in every way. We try to balance this reality with the reality that time is a very real factor when it comes to fertility, so knowing your options early is key. 

A consultation isn’t a commitment to treatment — it’s simply an evaluation to understand your body better. Dr. Ulrich shares, “If having genetically related children is important to you, don’t wait. Go talk with a fertility specialist. A consultation isn’t a commitment to treatment — it’s simply an evaluation to understand your body better. 

Sometimes the evaluation shows things look good and you can wait. Other times, it reveals that you may need to take action sooner. You wouldn’t know that without the consultation. If you’re under 35 and have been trying for a year, see a specialist. If you’re 35 or older and it’s been six months, don’t delay. That’s when the cost of waiting really starts to matter.”

As you consider your options and look into coverage, here’s a brief checklist to help you stay organized:

• Check your state mandate through RESOLVE’s insurance map: Does your state require IVF or fertility preservation coverage? (22 states + DC have laws, but details vary.)
• Ask about your employer plan: If your company’s plan is self-funded, state mandates may not apply. HR can confirm.
• Look for cycle or age limits: Even when IVF is covered, insurers may cap the number of cycles, set dollar limits, or impose age cutoffs.
• Clarify what’s included: Coverage often differs for donor eggs/sperm, genetic testing (PGT), surrogacy, or elective egg freezing.
• Consider fertility preservation: Many states require insurance to cover egg or sperm freezing for patients facing medical treatments like chemo. If there’s an option to freeze eggs or embryos while we wait on legislative decisions, this may put some people back in the driver’s seat.
• Review federal programs: Federal employees, veterans, and military families have unique rules—some cover IVF-related meds or limited services.
• Ask about step therapy: Some plans require trying IUI or other treatments before moving to IVF.
• Document and appeal: If coverage is denied, you can often appeal with your doctor’s support and/or bring the issue to the HR Benefits Manager at your company.

Moving Forward

As of the time of this writing in the Fall of 2025, the landscape of IVF coverage in the United States is both promising and frustrating: strides have been made, yet glaring gaps remain. Patients are often left navigating a patchwork of policies, costs, and misconceptions while balancing one of the most time-sensitive medical journeys of their lives. 

The truth is, progress in legislation and insurance expansion takes time — sometimes years — and while advocacy is moving the needle, patients and families always can’t afford to put their lives on hold waiting for systemic change.

For now, you can educate yourself, get clarity on your personal coverage, and seek medical guidance early. Every journey is different, but information is power. At pregnantish, we’re committed to continuing to spotlight the progress, name the challenges, and share the resources you need so you can move forward with both knowledge and hope.

Have Questions?

For more on coverage, visit RESOLVE: The National Infertility Association.

To book a consultation with Dr. Nicole Ulrich or any of the fertility specialists in the First Fertility network, visit FirstFertility.com.  

Follow pregnantish for more information and real talk about fertility.