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

What you need to know about IVF mandates:

• IVF coverage is not federally mandated — state laws vary widely, and most leave significant gaps that only employers can fill
• As of 2026, 25 states and D.C. have fertility insurance laws on the books, but the scope, eligibility, and plan types covered differ dramatically by state
• Most large employers are self-insured, meaning state mandates don't apply — making voluntary fertility benefits a business decision, not just a compliance one
• Organizations that build strong fertility benefits now will be better positioned to attract and retain talent as the landscape continues to shift

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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.

Federal law has never required health plans to cover infertility treatment, leaving coverage decisions to individual states — but that landscape is shifting fast. Twenty-five states and Washington, D.C. now require some form of private insurance coverage for fertility care, and 2026 has brought a wave of new activity at both the state and federal level. Over half of U.S. states introduced or carried over fertility coverage legislation in 2026, and California's SB 729 — which took effect January 1, 2026 — now requires large group health plans covering 100 or more employees to cover up to three egg retrievals and unlimited embryo transfers, affecting an estimated nine million enrollees.

Federally, following a February 2025 executive order on expanding IVF access, the Departments of Labor, Treasury, and HHS proposed a rule in May 2026 that would create a new excepted-benefit category specifically for fertility care, allowing employers to offer fertility benefits — including IVF — outside their major medical plan, similar to how dental or vision coverage is structured today. The proposed rule doesn't mandate coverage, and employers still aren't required to participate — but it signals where federal policy is heading, and it's accelerating a conversation employers can no longer treat as optional. See Maven's official comment on the federal proposal here.

The through line: coverage still varies dramatically by state and by employer, and IVF is far from a guaranteed benefit. However, fertility benefits are quickly becoming table stakes — and the organizations getting ahead of that shift, rather than reacting to it, are the ones best positioned for what's next.

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

As of 2026, 25 states and the District of Columbia have passed fertility insurance coverage laws. Of those, 15 states plus D.C. include a specific IVF coverage requirement for fully insured health plans. Yet even in these states, employers may not be required to cover infertility treatment and fertility preservation services if they're self-insured, have a religious exemption, or if they have fewer than 50 employees and are not required to comply under their state's law.

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. Get up-to-date information on each state's mandate with our interactive map.

States with comprehensive IVF and infertility insurance coverage

A core group of states — primarily in the Northeast and Mid-Atlantic — have strong and inclusive mandates, requiring coverage for IVF, IUI, diagnostics, fertility medications, and in many cases fertility preservation across most fully insured plan types.

Illinois and New Hampshire feature generous mandates in terms of sheer coverage depth. Both states require up to four egg retrievals per lifetime — the highest cycle limit of any state — and cover the full range of ART procedures. Illinois goes further than almost any other state by explicitly requiring coverage for donor egg cycles, and applies its mandate broadly to employers with 25 or more employees.

Massachusetts is widely considered among the strongest mandates in the country. It imposes no cycle cap and no lifetime dollar limit on IVF coverage itself, and covers fertility medications alongside treatment. Any insurer offering pregnancy-related benefits must extend the same coverage to infertility diagnosis and treatment.

New Jersey, Connecticut, and Rhode Island round out the Northeast cluster. New Jersey covers up to four cycles and includes fertility preservation. Connecticut requires coverage for up to two IVF cycles (along with up to four cycles of ovulation induction and up to three cycles of IUI), and applies its mandate to both individual and small group plans — broader reach than most states — and in 2026 lawmakers moved to expand the definition of infertility covered under the law. Rhode Island's mandate covers patients aged 25 to 42 on HMOs and plans that include pregnancy coverage.

New York requires large group plans to cover up to three egg retrievals, and also requires IVF through its Essential Health Benefits benchmark, meaning individual and small group plans are covered as well — one of the few states where coverage extends across plan types.

Maryland and Delaware both offer strong, modern mandates. Maryland covers up to three IVF cycles per live birth with a $100,000 lifetime cap, and notably expanded in 2024 to explicitly include same-sex couples and donor-related treatments. Delaware allows up to six egg retrievals with unlimited embryo transfers — the highest retrieval limit of any state — and covers donor egg cycles for patients diagnosed with infertility generally, as well as fertility preservation for patients facing iatrogenic infertility.

Colorado and Maine have strong mandates that apply primarily to large group plans. Colorado requires up to three egg retrievals with unlimited embryo transfers for employers with 100 or more employees, and has been in effect since 2023. Maine's mandate, also fully implemented in 2023, covers IVF and fertility preservation for large group plans.

Washington, D.C. deserves its own mention as one of the broadest mandates anywhere in the country. Effective January 1, 2025, D.C. requires plans to cover the diagnosis of infertility, three rounds of IVF, an embryo transfer to a surrogate if necessary, and fertility preservation before treatments that could impair fertility. D.C.'s essential health benefits benchmark plan is also being updated in 2026 to include coverage of the full range of fertility treatments — deepening access even further for residents on individual and small group plans.

California is the newest entrant to the comprehensive coverage tier. Under SB 729, effective January 1, 2026, fully insured large group health plans are required to cover infertility diagnosis and treatment, including up to three egg retrievals and unlimited embryo transfers. Critically, California's law explicitly includes same-sex couples and single individuals in its definition of infertility — one of the most inclusive expansions in the country. Small group and individual plans are not yet covered, though California has submitted a federal benchmark plan update that, if approved, would extend that requirement to smaller plans starting in 2027.

States with more targeted coverage

Florida enacted a fertility preservation mandate in 2025 that took effect January 2026, though it is limited to enrollees in the state employee health benefit plan who are diagnosed with cancer and face infertility as a result of treatment — it does not apply to most private insurance plans.

Georgia and Nevada both enacted fertility preservation mandates in 2025 that took effect January 2026, though these are targeted to patients facing specific medical conditions. Georgia's mandate covers patients with iatrogenic infertility from conditions such as cancer, sickle cell disease, and lupus. Nevada's mandate covers fertility preservation specifically for patients diagnosed with breast or ovarian cancer — not iatrogenic infertility from other causes.

Arkansas mandates IVF coverage but with significant restrictions: a $15,000 lifetime cap, a requirement that less expensive treatments like IUI be tried first, and a provision that eggs must be fertilized using a spouse's sperm — which excludes LGBTQ+ couples and single parents by choice.

Hawaii was an early adopter but remains restrictive: the state covers one IVF cycle for eligible patients, limited to those with a five-year infertility history or specific diagnoses, using their own eggs and sperm.

Montana requires insurers to offer coverage for infertility treatment, but does not specify whether IVF must be included. IVF coverage varies significantly between insurers and employer plans. A separate state law, enacted in 2023, mandates coverage of fertility preservation services when a member is diagnosed with cancer and the treatment could result in infertility. For most employees in Montana, IVF coverage depends entirely on what plan their employer chooses to purchase.

Texas is a "mandate to offer" state, not a "mandate to cover" state, meaning that insurers in Texas are required to make infertility coverage available, but employers can choose whether to purchase it. Legislation enacted in 2025 (TX SB833) updated coverage conditions for plans that do elect IVF benefits — reducing the required infertility history from five years to three and removing the previous requirement that fertilization could only be performed with a spouse's sperm — with these changes taking effect for plans issued or renewed on or after January 1, 2026. Still, the majority of Texas employees — particularly those on self-insured employer plans — have no guaranteed IVF coverage under state law.

Oklahoma has no IVF insurance mandate. Starting January 1, 2025, Oklahoma requires health benefit plans to cover standard fertility preservation services for individuals diagnosed with cancer whose medically necessary treatment may cause infertility — but this is limited to cancer-related preservation only, and religious employers may apply for an exemption. For the vast majority of Oklahomans seeking IVF, coverage is entirely at an employer's discretion, with no state requirement to provide it.

Louisiana requires insurers to offer plans with infertility benefits, but IVF is explicitly excluded by statute — meaning patients may receive some coverage for diagnostic testing or certain treatments, but IVF costs are out-of-pocket unless an employer voluntarily adds coverage. Louisiana does require coverage of standard fertility preservation services when medically necessary treatment may cause iatrogenic infertility, with storage coverage capped at three years, though self-insured employers and religious employers may opt out.

West Virginia has a fertility coverage mandate on the books, but its real-world impact is limited. HMOs that offer basic health services are required to cover infertility, but the term "infertility" is not defined in the law — leaving significant room for carrier interpretation. For employers with fully insured plans, the mandate to cover infertility services exists, but the scope varies by carrier and may not function as a comprehensive IVF coverage requirement. Employees on self-insured plans receive no state-mandated protections at all.

Ohio requires HMOs offering basic health services to cover infertility when medically necessary, but IVF, GIFT, and ZIFT are not included in that requirement. Most Ohio employers will need to add fertility benefits voluntarily if they want employees to have access to IVF coverage — state law alone does not provide it. As with many states without a comprehensive IVF mandate, the burden falls on employers to make fertility care a benefit priority.

States with new or pending legislation to watch

The legislative landscape is moving fast, and several states have recently crossed new thresholds.

Virginia passed legislation directing its Health Insurance Reform Commission to incorporate IVF into the state's essential health benefits benchmark plan — a process that resulted in a bill to require coverage of up to three IVF cycles per lifetime, with requirements taking effect in 2028.

Minnesota has proposed legislation titled the Minnesota Building Families Act, which requires large group health plans (over 25 employees) offering maternity coverage to also cover infertility diagnosis and treatment, including IVF with up to four egg retrievals per lifetime and unlimited embryo transfers. Religious exemptions exist.

States with limited or no IVF insurance coverage

Utah has limited IVF coverage that applies primarily to Medicaid patients with specific genetic conditions and state public employees — not to most private insurance plans.

New Mexico provides partial infertility coverage through its Essential Health Benefits benchmark plan, covering diagnosis and some treatment for individual and small group plans, but without an explicit IVF mandate.

The Federal signal — What the proposed IVF benefit rule means for employers

For years, IVF coverage has been a state-by-state patchwork — no federal floor, no requirement that employers offer it at all. That's starting to change, and the shift says as much about how fertility benefits are perceived as it does about policy.

On May 10, 2026, the Departments of Labor, HHS, and Treasury jointly proposed a rule that would let employers offer fertility benefits — including IVF, diagnostics, medications, and counseling — as a standalone "excepted benefit," structured similarly to dental or vision coverage and exempt from certain ACA requirements. The proposal follows February 2025's Executive Order 14216, which made affordable IVF access a stated policy priority.

Coverage would cap at $120,000 per participant lifetime, employers choose which services to include within that scope, and nothing about it is mandatory. The rule, if finalized, would take effect for plan years beginning January 1, 2027, following a public comment period that closes July 13, 2026.

Fertility benefits have long been framed as a premium perk reserved for employers competing hardest for talent. This proposal, from an administration that has made IVF access a named priority, treats it instead as a gap in the standard benefits stack that needs fixing — a framing shift that crosses the usual political lines.

In a labor market where fertility benefits are becoming table stakes, the employers shaping their fertility strategy now — ahead of any final rule — will be the ones positioned to compete on it, not catch up to it.

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.

As of 2024, 47% of employers with 500 or more employees now cover IVF, and 42% of all employers offer some fertility-related benefit, up from 30% in 2020.

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.