Does My Insurance Cover IVF? Here's How to Check Your Benefits

One of the first questions people ask when considering fertility treatment is, "Does my insurance cover IVF?" Coverage varies widely, so the answer depends on state laws, your employer’s plan, and how your insurer defines infertility and medical necessity.

Below, we’ll show you how to check your benefits, what to ask your insurance provider, how to understand your coverage, and ways to afford IVF without insurance.

In this article:

• Does My Insurance Cover IVF?
• State Mandates & IVF Coverage
• What IVF Services May Be Covered
• How to Find Out If Your Insurance Covers IVF
• 10 Questions to Ask Your Insurance Rep
• When to Involve Your Employer or HR
• What to Do If Your Plan Doesn't Cover IVF
• Appealing Insurance Denials for IVF
• How to Afford IVF Without Insurance
• Frequently Asked Questions

Does My Insurance Cover IVF?

While progress has been made, there is still no universal rule that determines whether IVF is covered. Insurance coverage for IVF typically depends on four main factors:

1. The state your insurance plan is issued in
2. Whether your employer’s plan is fully insured or self-funded
3. How your insurance company defines infertility and medical necessity
4. Which fertility services are included or excluded in your specific plan

Some insurers reference clinical guidance from the American Society for Reproductive Medicine (ASRM) when determining whether fertility treatment is considered medically necessary. However, even when medical necessity criteria are met, coverage still varies based on each plan's design.

State Mandates & IVF Coverage

Some states require certain insurance plans to cover infertility treatment, but not all require IVF coverage specifically. These laws are known as fertility insurance mandates, and they vary widely. However, state mandates do not apply to every insurance plan.

Many employers offer self-funded (ERISA) plans that are exempt from state insurance mandates, which means coverage can still vary even if you live in a mandate state.

Does my state have an infertility coverage mandate?

Connecticut and New York both have state laws requiring certain health insurance plans to cover fertility treatment, and in some cases, IVF.

However, these laws do not apply to every plan, which can be confusing. Advocacy organizations such as Fertility Within Reach offer support understanding your insurance benefits for fertility treatment through online resources and one-on-one guidance.

If you’re curious about how your state handles fertility benefits, RESOLVE: The National Infertility Association maintains a state-by-state map of infertility insurance laws.

Infertility, redefined.

Learn how the American Society for Reproductive Medicine's updated definition of infertility will increase fertility coverage for more hopeful parents.

What IVF Services May Be Covered

Every insurance plan is different, which means what is covered for one person may look very different for another. Instead of assuming you have no coverage (or full coverage), it’s helpful to look at coverage in a few general categories.

Commonly Covered

Many plans will cover the initial steps of fertility care, such as meeting with a fertility specialist and getting diagnostic testing done to understand what may be preventing successful conception.

This often includes important pieces of the family-building puzzle, such as:

• Bloodwork
• Semen analysis
• Diagnostic ultrasounds
• Medications that help support ovulation

If in vitro fertilization (IVF) is included in your plan, certain core components of a standard IVF cycle may also be covered.

Sometimes Covered

Some parts of treatment fall into a gray area, where coverage depends on your exact plan language. For example, monitoring appointments during IVF, anesthesia fees, or the laboratory work involved in fertilizing eggs may or may not be included.

Coverage for fertility preservation (such as freezing eggs or embryos for medical reasons, like before cancer treatment) is becoming more common, but is still plan-dependent.

Often Not Covered

Some services are frequently excluded entirely. These often include:

• Elective egg freezing (for future family-building, not due to a medical condition).
• Storage fees for frozen embryos, eggs, or sperm.
• Preimplantation genetic testing (PGT) of embryos.
• Integrative wellness services (like acupuncture) which are often considered optional or non-essential by insurers unless specifically noted otherwise.

If your plan has an exclusion clause for IVF itself, that means the procedure will not be covered, even if other parts of fertility care are.

Your Next Step

After you’ve begun to identify services that may or may not be covered by your plan, you'll want to speak directly with your insurance provider. This will help you confirm your specific benefits and get a better idea of what fertility treatment costs look like under your plan.

Next, we’ll guide you through exactly how to do that.

How to Find Out If Your Insurance Covers IVF

Once you have your insurance card in front of you, call the member services number and say that you’re seeking clarity on your fertility and IVF benefits. You don’t need to know all the proper terminology or reference complicated medical billing codes.

The goal is simply to understand what is included and what might require prior approval.

10 Questions to Ask Your Insurance Rep

You might start by saying something like: "I am exploring fertility treatment. Can you walk me through what my plan covers related to infertility diagnosis and IVF?"

From there, you may also want to ask:

1. Do I have coverage for infertility diagnosis and treatment?
2. Does my plan include coverage for IVF treatment specifically?
3. How does my plan define infertility and medical necessity?
4. Are there steps required before IVF is approved (like timed intercourse or IUI)?
5. Does IVF require prior authorization?
6. Are there limits on the number of IVF cycles covered (per year or lifetime)?
7. Which fertility medications are covered, and what will my out-of-pocket costs be?
8. Are monitoring appointments (bloodwork and ultrasound) included during IVF?
9. Are anesthesia and lab fees included, or billed separately?
10. Are embryo or egg storage fees covered, and if so, for how long?

Take your time. It's okay to ask the representative to slow down or repeat things. Write down the rep's name and the call reference number before ending the conversation.

Write down the representative’s name and the call reference number before ending the call.

When to Involve Your Employer or HR

If some details still feel unclear or inconsistent after calling your insurance company, check in with your employer’s HR or benefits team.

Some patients are surprised to learn that their employer has more influence on coverage than the insurance company itself. This is especially true if your plan is self-funded.

Remember: Reaching out to HR does not mean you are being difficult or asking for special treatment. You are simply asking for information that helps you plan your care and understand your benefits - which you are fully entitled to.

You might say: "I am trying to understand what fertility testing and treatment coverage is included in our plan. Could you clarify how fertility and IVF benefits are handled?"

Helpful Questions to Ask HR

Your HR team can help you understand your options and your timeline. Here are a few clarifying questions to ask them:

• Is our health plan self-funded or fully insured?
• Does our current plan include IVF coverage?
• If IVF is excluded, is there an option to add fertility benefits or request an exception?
• Does our company work with Carrot, Progyny, or another fertility benefits program?
• Is there a process to request additional coverage or submit a benefits review?
• When is our company's next open enrollment period?

If your current plan does not cover infertility, ask the following questions:

Is there another plan I can switch to that does include infertility?

If switching plans is an option, make sure to clarify if there are any restrictions on using your new fertility benefits. Some insurance companies require a certain amount of time to pass before dipping into benefits like infertility coverage.

Are there any ways to supplement fertility coverage?

Some employers offer fertility supplementation or reimbursement separate from their health insurance. You may need to purchase an insurance rider on top of your current plan, or a separate package through another benefits provider (such as Carrot or Progyny). 

Are there any company policies that can support me?

If you discover you have no opportunity for fertility coverage supplementation, there’s still a possibility that your employer could help support your journey in other ways. For example, offering a more flexible work schedule, more paid time off or sick days, etc.

Tip: Download RESOLVE's Coverage at Work Employee Toolkit to learn how to approach your employer and push for expanded fertility benefits at your company.

By gathering information from both your insurance provider and your employer, you will have a much clearer picture of your starting point. From there, your Care Team and Financial Coordinator can help you understand your options and plan your next steps.

What to Do If Your Plan Doesn't Cover IVF

Learning that your insurance plan doesn't cover IVF can feel devastating. You may be frustrated, confused, or worried you have to put your family-building plans on hold.

However, this doesn't mean it's the end of the road. Many fertility patients start from this exact place and still find a way forward. We're here to help you understand your options, lower financial stressors, and map out a plan with you that feels doable.

Your Next Steps

Start with a few small actions that bring clarity and control:

1. Ask for the denial in writing: Save the letter and any notes from your call.
2. Email your Financial Coordinator: Share your insurance plan name, denial letter, and any prior authorization numbers.
3. Consider your timeline: Some patients want to move forward now. Others want to wait for the next open enrollment period or explore IVF grants or financing options first. 

Appealing Insurance Denials for IVF

While some insurance denials are final, others can be appealed successfully. If you want to proceed with an appeal, here's what to do next:

• Request the reason for denial and the policy criteria.
• Ask your Care Team whether you meet medical necessity requirements, and whether clinic-provided documentation can be clarified.
• Submit a simple appeal letter with supporting notes from your physician.
• Note your insurer's timeline - appeals often have strict due dates.

More Resources

• PatientsLikeMe
• Fertility Within Reach
• CT Healthcare Advocate

How to Afford IVF Without Insurance

Below are the most common ways patients fund care when IVF is not covered by insurance. You can mix and match various to create a strategy that fits your needs.

1. Medication Savings Programs

IVF medication costs can vary widely, which is why reducing pharmacy spend is often one of the fastest budgeting wins. There are various ways to save money on prescriptions:

• Use our Medication Savings Checklist to compare pharmacies and stack discounts.
• Explore manufacturer assistance programs and discount cards where eligible.
• Confirm which medications must be brand name versus generic.

2. IVF Grants & Financial Assistance

Many patients find that they are eligible for partial (or even full) support from reputable organizations. Receiving an IVF grant offers a life-changing opportunity to build your family!

• Explore our extensive list of grants and aid programs.
• Apply to several programs at once. Stagger deadlines to keep momentum.
• Use our IVF Grant Application Guide to shortlist programs and track deadlines.
• Gather required documents early (such as a letter of medical necessity) as it takes time.

3. Fertility Financing Programs

In some cases, responsible borrowing can make costs more manageable. However, it's essential to carefully review the details and understand which red flags to look out for. To explore your financing options:

• Compare trusted lenders and learn how to avoid hidden fees and other surprises.
• Look at total cost, APR, repayment term, early payoff penalties, and late fees.
• Consider a smaller loan to cover medications only if your clinic cycle fee is manageable.

4. Bundled Self-Pay Plans

Most fertility clinics offer special packages or bundled services for self-pay patients in order to make treatment more accessible. At Illume, we have several options designed for those without insurance coverage for fertility treatment (including IVF).

Ask your Financial Coordinator to explain any applicable self-pay plans.

6) Using HSA & FSA Funds

Did you know that using pre-tax dollars can reduce your out-of-pocket costs?

• If available, set or adjust HSA and FSA contributions during open enrollment.
• Keep all receipts and Explanation of Benefits documents for tax time.
• Ask your tax professional about medical expense deductions when applicable.

Disclaimer: This information is for informational purposes only and does not constitute financial, legal, or medical advice. Illume Fertility does not endorse or guarantee any specific lender or outcome. Review all terms and consult qualified financial or legal professionals before making decisions.

Visit Our Finance Hub

We encourage you to explore our comprehensive Finance Hub, which offers detailed resource pages to give you clear answers and reduce research time.

• Illume's Accepted Insurance Plans
• Medication Coverage & Savings Programs
• IVF Grants & Aid Programs
• Fertility Financing Options
• Financial Planning For Fertility Treatment (eBook)
• Fertility Treatment Cost Overview

Frequently Asked Questions

Quick, clear answers to some of the most common questions we hear from patients.

How do I check if IVF is covered by my plan?

1. Start by downloading your Summary of Benefits and Coverage from your insurer’s website.
2. Call the member services number and ask whether IVF is included, whether prior authorization is required, and whether there are any steps you must complete before IVF is approved.
3. Write down the insurance representative’s name and call reference number.

What does "medical necessity" mean for IVF coverage?

Some plans require you to meet specific criteria to qualify for IVF. This can include a certain amount of time trying to conceive or completing other treatments first.

If medical necessity needs to be documented, your Care Team can help with this.

Note: If you don't have a traditional infertility diagnosis (e.g., are planning to become a single mom by choice or are an LGBTQ+ couple in need of family-building assistance), these specific criteria may or may not apply. 

What’s the difference between a fully insured plan and a self-funded plan?

Fully insured plans follow state insurance laws. Self-funded plans are created by employers and may be exempt from state mandates.

Does a state mandate mean I automatically have IVF coverage?

Not always. Connecticut and New York have strong fertility coverage laws, but many employers use self-funded plans that are not required to follow those laws.

Are fertility medications covered if IVF is covered?

Sometimes! Medication coverage often depends on prescription tiers, copays, and prior authorization rules. Ask your insurer which medications are covered and whether brand or generic versions are required.

Feeling stuck?

Understandable! It's normal to feel discouraged when you don't get the answers you were hoping for - especially when it's about something as monumental as building your family.

To help avoid overwhelm and keep building momentum, start small:

1. Take one action now, even if it's just looking into IVF grants or emailing HR.
2. Tell your Care Team how you are feeling. We can slow the pace and help you prioritize.
3. Consider a counseling session or attend a support group to gain perspective.

You're not alone - and support is available.

When you're ready to discuss your options, speak with one of our New Patient Liaisons and schedule your initial consultation. We're here to provide compassionate guidance, expert recommendations, and help you build a realistic plan that fits your unique goals and budget.