In what states is IVF covered by insurance?: A comprehensive guide for HR leaders

‍In vitro fertilization (IVF) is a type of assisted reproductive technology (ART) where sperm and an egg are fertilized outside the body. In 2021, 2% of all infants born in the United States were conceived using ART. While there are other methods of ART, IVF is by far the most common, representing 99% of ART procedures performed.

Many different people may opt to grow their families via IVF, including those with infertility diagnoses or existing health conditions, LGBTQIA+ couples, those who have previously frozen their eggs and sperm, and single parents.

Including prescriptions, bloodwork, and genetic testing, a single cycle of IVF can cost up to $30,000 without health insurance coverage, and it takes the average person 2.5 cycles to achieve pregnancy. As such, insurance coverage for IVF treatments often determines if people needing fertility treatment are able to afford to grow their families or not.

Since federal law does not require any health plans to cover infertility treatments, these services are left up to individual states. Many states still consider in vitro fertilization treatments to be "boutique" or "elective" reproductive medicine, despite often being the only tenable option for LGBTQIA+ couples, single parents, and people with a diagnosis of infertility. Even if state insurance laws offer infertility coverage, IVF coverage can still vary greatly from state to state.

Understanding IVF and its impact on family building

What is IVF?

IVF involves retrieving eggs from ovaries and manually combining them with sperm in a lab for fertilization, after which the fertilized egg known as the embryo is placed inside the uterus. The process begins with suppressing the menstrual cycle and stimulating egg production before the egg retrieval, also known as oocyte retrieval. Once the eggs are collected, they are combined with sperm from either the partner or a donor and become embryos, which can then be transferred back to the uterus. Any additional suitable embryos can be frozen for future IVF attempts.

Medical conditions that may necessitate IVF include blocked fallopian tubes, low sperm count, endometriosis, and unexplained infertility.

IVF differs from intrauterine insemination (IUI), where sperm is injected directly into the uterus. Since IUI is less invasive and less expensive, many people opt to start there; however, due to its lower success rate, many people who try IUI first then go on to seek IVF treatment.

Many factors can affect IVF success rates. Since the quality of eggs and sperm deteriorates as people get older, reproductive age has a negative correlation with IVF success. Other important factors include prior successful pregnancies, a smooth embryo transfer, maintaining a healthy weight, and abstaining from smoking and alcohol.

In addition to the financial implications, IVF can often cause serious physical and emotional strain for families. The synthetic hormones in the ovulation-stimulating fertility drugs can cause intense PMS, weight changes, headaches, and nausea. Moreover, many of these drugs need to be injected, often for weeks at a time. Beyond physical discomfort, the process can be incredibly emotionally taxing and stressful.

The impact of these stressors seeps into all aspects of life, including the workplace. Nearly nine out of 10 employees feel their fertility challenges significantly impacted their productivity at work and 50% say it decreases their job satisfaction. Moreover, nearly one in five employees end up leaving their jobs because of the impact of fertility treatment.

The importance of IVF coverage

The cost of one IVF cycle ranges from $12,000 to $14,000, not including components of the process that clinics treat as add-ons to that base fee. While the clinic's base fee often includes monitoring appointments, bloodwork, and egg retrieval, it may not cover the injectable hormones, which can cost an additional $3,000 to $6,000. Other additional charges include genetic testing, trial transfers, cryostorage for unused embryos, donor sperm, or medical or hospital expenses.

Including these additional services—many of which may be necessary and required—the total bill for a single round of IVF typically ranges between $23,000 and $30,000. Considering that many people need more than one IVF cycle to achieve pregnancy, these costs quickly become prohibitive.

Infertility treatment coverage can make IVF more accessible and affordable, preventing people from going into debt or forgoing building their family altogether. As such, employers can play a key role in removing barriers to access. The business case for employers to support their employees as they start or grow their families is clear. While infertility insurance helps to improve diversity, equity, and inclusion in the workplace, other business advantages include better employee retention, recruiting better talent, and improved employee morale.

States with mandated IVF insurance coverage

Overview of state mandates

As of September 2023, 21 states and the District of Columbia have passed fertility insurance coverage laws. Only 15 of those laws include IVF coverage, and 17 laws cover fertility preservation services for iatrogenic, or medically-induced, infertility.

Even in these states, employers may not be required to cover infertility treatment and fertility preservation services if they’re self-insured, or if they have fewer than 50 employees and are not required to provide health insurance coverage. Religious organizations may also be exempt.

Another distinction between these state insurance laws is the difference between a mandate to cover and a mandate to offer. In mandated coverage laws, health insurance companies must provide coverage for infertility services in every policy, whereas mandated offer laws only require insurance companies to make this coverage available for purchase.

States with comprehensive IVF and infertility insurance coverage

Only 11 states require both IVF and fertility preservation coverage: Colorado, Connecticut, Delaware, Maryland, Maine, New Hampshire, New Jersey, New York, Rhode Island, Utah, and Washington D.C.

Massachusetts and Arkansas have mandated IVF coverage but not fertility preservation coverage, which would include freezing eggs, sperm, and embryos. California and Texas are mandate-to-offer states, meaning health insurance plans must have an infertility insurance option but are not required to provide it in any or all plans.

In Colorado, all large group (100+ employees) health benefit plans must cover up to three completed egg retrievals with unlimited embryo transfers. This Colorado law also specifies that fertility medications must be treated as all other prescription medications.

New York has similar legal requirements for all large group health plans to cover up to three IVF cycles and prescription medications, with an added clause that prohibits insurance coverage discrimination based on age, sex, sexual orientation, marital status, or gender identity.

Even the definition of what constitutes infertility varies significantly from state to state. For a comprehensive breakdown of fertility coverage laws by state, visit RESOLVE, the national infertility association.

States with limited or no IVF insurance coverage

Even among the 21 states and D.C. that have some sort of state-specific infertility treatment legislation, many of them are restrictive and discriminatory.

For example, Arkansas law stipulates that a patient's eggs must be fertilized with her partner's sperm, thus excluding LGBTQIA+ couples and single parents, a stipulation that persists in other states including Texas and Hawaii.

Further, these state laws often do not apply to self-insured plans, which cover 61% of workers in the U.S. The remaining 29 states do not require private insurance to cover any fertility services.

The role of employers in providing IVF coverage

Employer-sponsored IVF and fertility treatment benefits

Given the limitations and restrictions that exist in states with some sort of mandated fertility coverage, employers play a crucial role in expanding equity and access across the country.

Currently, 31% of employers offer fertility benefits. The types of fertility coverage vary, with 30% of employers covering IVF in 2022. The majority of this coverage comes from large companies, with 37% of employers with 20,000+ employees covering IVF. 81% of Best Workplaces provide reimbursement for fertility treatments.

Advantages of offering IVF coverage

There's a reason why so many employers are making the shift and covering employees' IVF treatments—it makes good business sense. 91% of global employers say family benefits are extremely important to their employees.

Further, 97% of employers say that they have not encountered any significant increases in medical plan costs by offering this coverage, yet this provision results in more loyal and committed employees, higher workforce morale, and an improved ability to attract top talent by improving company reputation. More than 60% of employees report increased loyalty to their employers when they provide family benefits.

Inclusive company culture boosts employee morale and engagement, and highly engaged teams have lower turnover rates, leading to increased productivity and decreased hiring and training costs.

Steps for employers to implement IVF coverage

To implement enhanced fertility benefits, employers should start by assessing their existing fertility and family-building benefits policies, as well as checking specific state legislation. Some things to check for include equitable access for LGBTQIA+ and single employees, whether or not current plans require a diagnosis of infertility for coverage, and if domestic partners can receive benefits. Employers should also survey employees to better understand their experiences with existing benefits and policies and identify gaps.

Since creating a comprehensive and inclusive fertility and family-building benefits plan can be daunting, Maven can be a valuable partner for companies looking to improve their offerings. As the leading women's and family healthcare company, Maven provides a suite of benefits to support fertility and family building. With Maven, 96% of Fertility & Family Building members are more loyal to their employer because they implemented Maven.

Once new benefits are implemented, a strong communication plan is critical to ensure they are utilized. Nearly half of employees don’t fully understand their benefits, so companies should use their various channels—including intranet, email, Slack, social media, office hours, and live Q&A sessions—to spread the word. Since good benefits are increasingly important to Gen Z and millennial job applicants, this benefits communication should be included in recruitment as well.

Financial assistance and alternatives for IVF coverage

Financial assistance programs

Beyond specific benefits plans, employers can support their employees seeking to start or grow their families in other ways too. Financial assistance and fertility grants are now offered by non-profit organizations, and unlimited IVF cycle packages and IVF treatment refund programs are more common. Additionally, financing solutions for employers wanting to provide financial help toward IVF to their employees are gaining popularity.

Offering a group coverage HRA or health stipend can give employers more flexibility while still reducing employees' financial burden. They can also encourage employees to use their pre-tax health savings accounts (HSAs) and flexible spending accounts (FSAs) to alleviate some of the cost when accessing fertility treatment.

To further reduce associated costs, it's important to focus on preconception care and clinic quality. In fact, 30% of Maven Fertility & Family Building members avoid IUI/IVF treatment altogether through preconception coaching and other resources. 

Future trends and legislative efforts in IVF coverage

Emerging trends in IVF health insurance coverage

Employees continue to seek out and demand comprehensive fertility benefits, with 57% of employees taking another job or considering leaving their employer in search of better reproductive and family benefits. These benefits are especially important for younger generations in the workforce—35% of millennials and 46% of Gen Z report that reproductive and family health benefits influence their decision to stay at their job or take a new one.

With increased access to virtual healthcare through partners, employers can further reduce associated costs and employees can access high-quality, culturally humble care without diminishing their productivity at work. With Maven, 60% of provider appointments take place outside of business hours, showing the need for more flexible options.

Legislative efforts and potential changes

Groups like RESOLVE are leading the fight to expand insurance coverage by tracking current legislation and lobbying at a state and federal level. The proposed Access to Infertility Treatment and Care Act (HR 2803 and S 1461) would require all health plans offered on group and individual markets to provide infertility treatment, but it has not yet made it out of Congressional committee.

RESOLVE is also fighting against proposed personhood laws that would recognize embryos from the moment of fertilization as humans with legal rights. These personhood laws would be problematic for anyone handling frozen embryos and could increase costs drastically. While RESOLVE has already helped defeat more than 100 personhood bills across the country, more bills continue to be introduced.

In light of the current political landscape, employer sponsored health insurance is even more important, especially in providing access to fertility treatment.

Building better fertility care with Maven

Offering comprehensive family-building benefits can be daunting, but you don't have to do it alone. Maven, the leading women's and family health company, can be a valuable partner for your employees' family needs at every step of their journey.

We offer an integrated platform that provides clinical, emotional, and financial support all in one place. Your employees deserve care that is compassionate, knowledgeable, and accessible during fertility treatment and beyond, and Maven is here to help.

Find out more about offering fertility benefits with Maven by requesting a demo today.