When you’re navigating the emotionally and financially demanding path of fertility treatment, few questions matter more than: Will my insurance cover this? Understanding fertility treatment coverage is a critical part of planning your fertility journey. Unfortunately, the answers aren’t always clear-cut. Coverage varies widely based on where you live, what kind of plan you have, and how your insurer defines infertility and related services.
In this guide, we break down everything you need to know, from what’s commonly covered to what isn’t, and how to advocate for yourself or your family along the way.
What Is Infertility Insurance Coverage?
Infertility insurance coverage refers to the portion of your fertility treatment cost that is paid for by your health insurance plan. This may include diagnostic testing, medications, procedures like intrauterine insemination (IUI) or in vitro fertilization (IVF), and even fertility preservation in some cases. However, access to these benefits is far from uniform.
Medically, infertility is defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse (or 6 months if the person trying to conceive is over 35), or an inability to carry a pregnancy to live birth. Some insurance policies use this definition, while others also factor in physical findings, diagnostic assessments, and previous medical conditions like cancer or polycystic ovary syndrome (PCOS).
Despite infertility being recognized as a medical condition, many insurance plans do not provide comprehensive insurance coverage. This is largely due to a patchwork of state mandates, exceptions for religious employers and self-insured plans, and outdated assumptions about who needs fertility support. Insurance coverage often depends on:
- State laws and mandates.
- Whether your employer offers group insurance or is self-insured.
- Your insurance carrier and chosen plan.
- Your medical diagnosis and eligibility for certain medical treatments.
Which Infertility Services Are Typically Covered by Insurance?
While policies differ, there are several categories of infertility services that are commonly covered, especially in states with insurance coverage mandates or by more inclusive employer-sponsored plans.
Diagnostic Testing and Initial Visits
Your fertility journey typically begins with diagnostic testing, which may include blood work, ultrasounds, semen analysis, and physical exams to assess the health of the reproductive organs. Most insurance plans that offer infertility benefits will cover these initial assessments, especially if your doctor determines they’re medically necessary.
You’ll also likely have a consultation with a reproductive endocrinologist, who will analyze these results and guide you on potential treatment options. The good news is that many plans view this initial phase as part of basic health services, increasing the likelihood of insurance coverage.
Medications and Prescription Drugs
Fertility medications play a crucial role in many treatment protocols. Insurance may cover drugs used for:
- Ovulation induction, such as Clomid or Letrozole.
- Hormonal support, like progesterone or hCG.
- IVF preparation, including injectable gonadotropins.
Insurance coverage for fertility drugs varies. Some plans will include them under prescription benefits, while others categorize them separately under infertility services. There may be limits on dosage, number of cycles, or even the specific brands allowed under your insurance policy.
Fertility Treatment Procedures
Infertility treatments range in complexity and cost, and so does their health insurance coverage. Some of the more common infertility procedures include:
- Intrauterine insemination (IUI): Often covered, especially when performed after documented infertility testing.
- In vitro fertilization (IVF): Insurance coverage here is inconsistent; many plans limit the number of treatment cycles or cap total spending with a lifetime maximum.
- Therapeutic donor insemination and artificial insemination: Insurance coverage may depend on the reason for treatment (e.g., same-sex couples may face denials depending on the insurer’s policy)
It’s important to confirm whether your plan includes fertility treatment coverage, especially for IVF services, as this is one of the most expensive and commonly excluded infertility treatments.
Fertility Preservation Services
Fertility preservation is becoming more recognized, especially for patients undergoing medical treatments like chemotherapy or radiation that could cause iatrogenic infertility. Some states now require insurance coverage for standard fertility preservation services in these cases.
However, standard fertility preservations services (like egg or sperm freezing) for non-medical reasons is usually not covered. Patients should ask whether state health benefits programs or Medicaid services in their area include fertility preservation in medically necessary contexts.
In California, coverage for fertility preservation has historically varied depending on the insurance provider. Some plans voluntarily cover standard fertility preservation services when deemed medically necessary, while others exclude them altogether.
That said, California is moving toward stronger protections in this area. Under SB 729, starting January 1, 2026, fully insured group plans regulated by the state will be required to cover medically necessary fertility preservation procedures. This includes cases where patients are undergoing treatments likely to cause infertility.
However, fertility preservation for non-medical reasons is not included in the mandate and typically remains an out-of-pocket expense.
What’s Often Not Covered by Insurance Plans
Just as important as knowing what is covered is understanding what typically isn’t.
Experimental Procedures
Most insurance policies exclude any infertility treatments deemed experimental, including newer technologies or off-label medication uses.
Multiple IVF Cycles and Lifetime Maximums
Even if your plan includes IVF insurance coverage, it may cap the number of cycles or total spending. For example, your plan might cover only two cycles or up to $10,000 in total fertility benefits, known as a lifetime maximum. After that, you’re responsible for all out-of-pocket costs.
Fertility Preservation for Non-Medical Reasons
Freezing eggs or sperm due to age or personal reasons is rarely covered, as it’s considered elective. If you’re interested in these options, check whether your insurer distinguishes between therapeutic and elective fertility preservation.
Discrimination-Based Limitations
Some policies apply restrictions based on:
- Age (e.g., over 42 years old).
- Marital status.
- Sexual orientation.
- Gender identity.
- Preexisting conditions.
These policies are increasingly being challenged, but they still exist in many states and plans.
Religious or Self-Insured Employer Exemptions
Employers with religious affiliations or who are self-insured can opt out of state-mandated infertility insurance coverage. This affects many employees, even in mandate states.
Out-of-Network Services
Even when insurance coverage exists, your insurer may only cover in-network clinics. Visiting an out-of-network provider can lead to partial reimbursement, or none at all.
How Coverage Varies by State and Insurance Type
States with Infertility Insurance Mandates
Currently, 21 states have passed laws requiring insurers to either offer or cover infertility services. However, the details vary widely. Some states only require insurers to offer insurance coverage (meaning employers can choose whether to include it), while others mandate that they provide insurance coverage to all eligible enrollees.
California is considered a “mandate to offer” state – meaning health insurance providers are required to make infertility insurance coverage available to employers, but employers are not required to include it in their plans. The law mandates insurance coverage for the diagnosis and treatment of infertility, but does not require insurance coverage for in vitro fertilization (IVF). However, some employer-sponsored plans do voluntarily include IVF benefits, so it’s important for patients in California to check their specific policy details.
In recent years, there has been a growing movement in California to expand access to fertility services, including legislative efforts aimed at requiring broader insurance coverage of standard fertility preservation services and eliminating discriminatory barriers based on marital status, sexual orientation, or gender identity.
If you’re based in California, our clinic can help you interpret your insurance policy and determine whether you’re eligible for diagnostic testing, IUI, IVF, or preservation services under your current plan.
For other states, the best place to check updated details is Resolve.org’s insurance coverage by state tool, which offers summaries and links to relevant laws.
Medicaid and Infertility Coverage
Unfortunately, most Medicaid services across the U.S. do not include comprehensive infertility treatment coverage. However, there are exceptions depending on the state.
In California, the state’s Medicaid program (Medi-Cal) typically does not cover advanced treatments like IVF. That said, Medi-Cal may provide limited insurance coverage for diagnostic testing and certain treatments if infertility stems from an underlying medical condition. Insurance coverage is determined on a case-by-case basis and may require documentation of medical necessity. Patients enrolled in Medi-Cal are encouraged to contact their managed care plan or work with a clinic familiar with state health benefits programs to explore eligibility.
Employer-Sponsored and Private Health Insurance Plans
If you’re covered under a private or employer-sponsored plan, your fertility benefits depend heavily on:
- Whether your employer is fully insured or self-insured.
- If your plan is part of a small group market or large group insurer.
- Whether your company chooses to offer insurance coverage as an employee perk.
The good news: More employers, especially in tech, finance, and health sectors, are beginning to offer fertility benefits including IVF and fertility preservation. These programs may be handled through third-party providers like Carrot, which specialize in fertility benefit management.
Questions to Ask Your Insurance Provider
To avoid costly surprises, contact your insurance provider directly or work with your clinic’s financial team. Key questions to ask include:
- Does my plan include insurance coverage for infertility services or just diagnostics?
- Are there age restrictions, lifetime maximums, or limits on cycles?
- Are fertility drugs covered under medical or pharmacy benefits?
- What infertility treatments are excluded as experimental?
- Are same-sex couples, single individuals, or transgender patients eligible for insurance coverage?
- Do I need a referral or pre-authorization to begin infertility treatment?
- Which fertility clinics and labs are in-network?
Having answers to these questions can help you make informed decisions and reduce stress during your fertility journey.
What to Do If Your Insurance Doesn’t Cover Infertility
Facing a lack of insurance coverage can be discouraging, but there are still options.
In California, where IVF is not mandated under state insurance law, many patients face significant out-of-pocket costs for advanced infertility treatments. If your employer doesn’t voluntarily include these benefits, you still have paths forward.
Explore financing programs. Some fertility clinics offer fertility financing options – we surely do!
You can also apply for fertility grants available through nonprofit organizations.
Some employers in California, particularly in tech and healthcare, offer generous reimbursement programs or work with third-party fertility benefits platforms like Carrot. Others allow use of FSAs or HSAs to help manage costs.
Finally, you can advocate for insurance coverage. Talk to your HR department about adding fertility benefits to your plan, especially if you’re at a larger company. California continues to be at the forefront of legislative efforts to expand fertility access – so staying informed and proactive can pay off.
Helping You Navigate Infertility Insurance Coverage
At the California Center for Reproductive Health, we know that understanding insurance is one of the most frustrating parts of getting infertility treatment. But you’re not alone. Our dedicated team helps patients verify insurance benefits, estimate out-of-pocket costs, and navigate pre-authorizations every day.
We understand that navigating infertility insurance coverage can be overwhelming, but knowing your clinic is already contracted with your provider can make things much easier. Our fertility clinic is proud to be in-network with a wide range of major insurance providers, giving you greater access to the care you need with fewer unexpected costs.
We currently accept the following insurance plans:
- Aetna.
- BlueCross BlueShield.
- Cigna.
- Facey Medical Group.
- Regal/Lakeside Medical Group.
- Sierra Medical Group.
- Tricare.
- United Healthcare.
- WIN Fertility.
If you’re insured by one of these providers, we can help you understand your specific benefits, pre-authorizations, and any coverage limits that apply to your fertility treatment. We’ll work with you to make sure you get the most out of your insurance plan, every step of the way.
Not sure if you’re covered? We’re happy to walk you through the next steps. Schedule your appointment today and together, we can create a plan that balances affordability, medical need, and your family goals.
