Fertility Insurance Mandates: How Does My State Stack Up?

Many states require insurance companies to cover part, or all, of fertility care expenses. But this can be very tedious to sift through, and it varies by locale. For anyone even considering fertility testing or treatment, it’s good to know just what’s up in your state. 

Can you expect some help on the testing front? What about in vitro fertilization (IVF), are there any mandates for coverage here? So with no further adieu, here’s what you can expect in terms of your state’s fertility insurance:

Alabama

No fertility insurance here. Currently out of luck.

Alaska

No fertility insurance here. Currently out of luck.

Arizona

No fertility insurance here. Currently out of luck.

Arkansas

With Arkansas fertility insurance, you do have some benefits, albeit limited. If you have an individual or group policy that includes maternity benefits, IVF must also be covered, as well as cryopreservation. 

But, there is a lifetime cap of just $15,000 here. You also can’t just move right to IVF. First, you must try a less costly fertility approach such as undergoing an intrauterine insemination (IUI). Also, HMO’s and employers who self-insure are exempt.

California

California fertility insurance looks promising, but may be far less helpful than meets the eye. You will only receive coverage here if your employer decides they want to provide fertility coverage as part of their benefits package.

Fact is, here insurance companies only have to offer infertility coverage. It’s then up to employers to decide whether they want to include fertility treatment coverage for employees or not. 

Colorado

Thanks to some new legislation, as of January 1, 2023. Colorado fertility insurance now offers eligibility for three egg retrievals with unlimited embryo transfers covered. This is true provided that your insurance coverage is from a large group of 100 or more people. 

Those with individual or small group plans will unfortunately not have access to this coverage. Also, religious organizations, even large ones, are not required to provide fertility coverage.

Connecticut

With Connecticut fertility insurance, diagnosis and treatment of medically necessary infertility expenses must be covered. You may be entitled to up to two cycles of IVF, zygote intrafallopian transfer (ZIFT), or gamete intrafallopian transfer (GIFT), up to four cycles of ovulation induction and up to three cycles of intrauterine insemination.

But, only those who have had coverage under the policy for at least one year will be eligible. Also, if your employer self-insures, they do not have to provide this coverage, or, if they are a religious organization, this is also not mandated.

Delaware

Delaware fertility insurance offers an array of services that includes IVF with eggs, sperm, or embryos from a donor, and even allows for a surrogate or gestational carrier. You are even entitled to six egg retrievals with unlimited embryo transfers. 

But there is a hitch. This coverage is restricted to those with fertility issues as a result of a medical treatment such as chemotherapy, surgery, or radiation. Also, any egg retrieval must be done before age 45 and any embryos transferred before age 50. 

Florida

No fertility insurance here. Currently out of luck.

Georgia

No fertility insurance here. Currently out of luck.

Hawaii

While you can get some Hawaiian fertility insurance coverage that may be beneficial, it’s limited. You’re entitled to one and only one IVF cycle. That’s for those with a minimum of a five-year history of issues such as endometriosis, blocked or removed fallopian tubes, DES exposure, or male infertility factors.

You also can’t move on to IVF until you’ve tried other covered fertility treatment first. So, if you are eligible, you truly don’t want to give away your shot…

Idaho

No fertility insurance here. Currently out of luck.

Illinois

With Illinois fertility insurance coverage, provided you have tried lower-cost treatments under your insurance umbrella first without success, you do have coverage for IVF, GIFT, and ZIFT. What’s more, you get four bites at the apple and if you are successful and a live birth occurs, you’re actually entitled to two more covered egg retrievals.

But this only applies to work-related group policies that cover more than 25 full-time employees. There is, however, some additional good news. As of January 1, 2022, this fertility protection extends to same-sex couples and single-women over age 35 who have a medical issue keeping them from getting pregnant.

Indiana

No fertility insurance here. Currently out of luck.

Iowa

No fertility insurance here. Currently out of luck.

Kansas

No fertility insurance here. Currently out of luck.

Kentucky

No fertility insurance here. Currently out of luck.

Louisiana

The Louisiana fertility insurance law provides a fig leaf of coverage. You are only eligible here for diagnosis and treatment if your fertility issues are the result of a correctable medical condition. Even that has exceptions. There is no requirement to cover fertility medication or to offer IVF or even other fertility treatment. Also, if you or your partner have undergone a tubal ligation or vasectomy, any reversal here is on you.

If your employer self-insures, then even if you would be eligible otherwise, there’s no requirement that you be covered.

Maine

While this state doesn’t have any coverage at the moment, a Maine fertility insurance law will kick in beginning January 1, 2024. Then, fertility patients who have health plans here will be entitled to fertility diagnostic care, treatment and fertility preservation services. 

Coverage is expected to include both individuals and couples battling infertility, those who carry a heightened risk of transmitting a severe genetic disorder to an offspring with natural conception, and those who don’t have the needed reproductive cells to conceive. This coverage will exclude anything experimental or any non-medical related cost.

Maryland

With Maryland fertility insurance, you are golden. This insurance offers coverages not only to traditional heterosexual couples, but also same sex couples and unmarried patients. Those who qualify are entitled to undergo three IVF rounds for every live birth. There is, however, a $100,000 lifetime cap here.

But, this coverage is not a requirement for religious employers, those with fewer than 50 employees, or those employers who self insure.

Massachusetts

Massachusetts fertility insurance stipulates that insurers that provide pregnancy-related benefits are also expected to offer coverage for diagnosis and treatment of infertility. This means access to artificial insemination procedures such as IVF and GIFT. It may also include procurement of eggs or sperm, processing and banking for fertilized eggs and sperm. 

There’s also no state lifetime cap on the amount of fertility insurance available and no limit on the number cycles. But, insurers are able to use their clinical guidelines and patient’s medical histories to set some limits here. 

Michigan

No fertility insurance here. Currently out of luck.

Minnesota

Not only is there no Minnesota fertility insurance, but also there’s a law prohibiting coverage for meds specifically used to enhance fertility. Talk about kicking those already down… 

Mississippi

No fertility insurance here. Currently out of luck.

Missouri

No fertility insurance here. Currently out of luck.

Montana

Montana fertility insurance offers some vague help as long as you get your insurance through an HMO. But unfortunately, there’s no definition of infertility that’s given in the law and no description of the type of services that need to be covered. So, it appears to pay only lip service here. Anyone with non-HMO insurance has absolutely no coverage.

Nebraska

No fertility insurance here. Currently out of luck.

Nevada

No fertility insurance here. Currently out of luck.

New Hampshire

If you have a group policy that offers benefits for medical or hospital expenses, the New Hampshire fertility insurance mandate provides for medically necessary fertility treatment. This includes coverage for evaluations, laboratory testing, and medication. If fertility preservation is needed, such as if you must undergo chemotherapy or radiation treatment, coverage includes both procurement and cryopreservation of reproductive materials such as eggs, sperm, and embryos, and may even include storage for a time.

But experimental infertility procedures are not included. Also, anyone covered through the Small Business Health Options Program (SHOP) or have an Extended Transition to Affordable Care Act-Compliant Policy funded by the state, is not eligible here. 

New Jersey

With New Jersey fertility insurance, as long as you are under the age of 46 and have a group policy that includes at least 50 people, with pregnancy-related benefits, you are potentially eligible for a variety of infertility treatments. This includes a menu of items such as up to four IVF cycles with ICSI, GIFT, or ZIFT, as well as use of donor eggs and even the potential to use a gestational carrier or surrogate. 

But except in cases where the patient must undergo treatment that puts fertility at risk, such as chemotherapy, cryopreservation is not covered.

Also, there are some exceptions to which insurers must follow the mandate – neither religious employers or those who self-insure are required to provide this coverage.

New Mexico

No fertility insurance here. Currently out of luck.

New York

As part of a new law enacted in 2020, New York fertility insurance offers those who have large group insurance plans of 100 or more, up to three IVF cycles. Also, those that include prescription drug coverage must provide medication for the diagnosis and treatment of infertility. 

What’s more, it’s now necessary to cover egg freezing for all private insurance companies in medically necessary cases. So, you are eligible if you have a condition such as sickle cell anemia, are undergoing chemotherapy, or are undergoing sex-reassignment surgery. 

Those who self-insure are exempt here.

North Carolina

No fertility insurance here. Currently out of luck.

North Dakota

No fertility insurance here. Currently out of luck.

Ohio

Ohio fertility insurance must be covered in cases where this is medically necessary, by HMO’s that offer “basic health services.” But don’t count on coverage for IVF, GIFT, or ZIFT. None of these are legally required. 

What you may be covered for includes diagnostic procedures to detect fertility issues, or surgical treatments to correct issues with the reproductive organs such as endometriosis or issues with the fallopian tubes.

Oklahoma

No fertility insurance here. Currently out of luck.

Oregon

No fertility insurance here. Currently out of luck.

Pennsylvania

No fertility insurance here. Currently out of luck.

Rhode Island

The Rhode Island fertility coverage is mandated for all of those with an HMO or other insurance policy that includes pregnancy coverage. Beginning at age 25 and extending up to age 42, women here with such a plan are entitled to coverage for diagnosis and treatment of infertility. 

Also, if someone is undergoing a procedure that may result in infertility, insurers must cover fertility preservation treatment. There is, however, a $100,000 lifetime treatment cap. 

South Carolina

No fertility insurance here. Currently out of luck.

South Dakota

No fertility insurance here. Currently out of luck.

Tennessee

No fertility insurance here. Currently out of luck.

Texas

With Texas fertility coverage, although insurance companies must provide this as an option, there is no mandate that any group is required to actually offer this as part of their health plan. In instances where such coverage is offered, it only pertains to those who can show that they’ve been infertile for at least 5 years or who have a medical issue such as endometriosis, tubal blockage or removal, or DES exposure. 

Also, IVF won’t even be considered until less costly measures, like IUI, have been tried. 

Utah

Utah’s fertility coverage involves a pilot program through 2024. This targets those who are on a Public Employee Health Plan. Here, if you have a maternity benefit, then you must likewise be able to receive $4,000 toward a “qualified reproductive technology cycle.” With this, just a single embryo is transferred during a cycle using reproductive technology.   

This, however, is not a mandate. The aim of the program is to determine the efficacy of providing this kind of coverage. 

Vermont

No fertility insurance here. Currently out of luck.

Virginia

No fertility insurance here. Currently out of luck.

Washington

No fertility insurance. Currently out of luck.

West Virginia

The West Virginia fertility insurance mandate is low on details. While HMOs that offer basic health services are required to cover infertility, what “infertility” actually means here is not defined. All in all, this is way too vague – more clarity needed here.

Wisconsin

No fertility insurance here. Currently out of luck.

Wyoming

No fertility insurance here. Currently out of luck.

When coverage is lacking

If you’re lucky enough to live in one of the 20 states that offers a fertility insurance mandate, that’s, of course, a big win. Still, as you can see, even these can leave you wanting. If your state doesn’t deliver on fertility coverage or if the coverage is, in a word, lacking here, reach out to Resolve: The National Fertility Organization to find out who to contact to lobby for improvements.