Fertility benefits by state: what insurance covers IVF and where coverage is mandated (2026 guide)

Fertility benefits have gone from a “nice-to-have” perk to a major priority for employees and employers alike. But even as demand rises, coverage remains inconsistent and confusing.

That’s because what insurance covers IVF and other fertility care often depends on where you live, what kind of plan you have, and whether your state has a fertility coverage mandate.

To help HR and benefits leaders, employees, and anyone researching fertility coverage, we put together this guide to fertility benefits by state, including an A–Z list of state laws that require certain insurance plans to cover infertility diagnosis and treatment.

Why fertility benefits matter (and why coverage is such a big deal)

Fertility care is expensive, and many people can’t access treatment without insurance support.

One IVF cycle can cost up to $35,000, and that total can increase quickly when you factor in medications, genetic testing, and multiple cycles. Meanwhile, infertility is common, and more people are pursuing family-building options later in life or through nontraditional paths.

That combination, high costs plus high demand, is why fertility benefits have become one of the most requested and discussed areas in employer-sponsored health coverage.

At the same time, fertility benefits are one of the most complicated categories of care to evaluate, because coverage depends on:

• The state you live in
• Whether your plan is fully insured or self-funded
• What your insurance carrier includes by default
• Whether your employer has chosen to add or expand fertility benefits voluntarily

What are fertility benefits?

Fertility benefits are health plan benefits that help cover the cost of infertility diagnosis, fertility treatment, and family-building services.

Some fertility benefits are included directly in a medical plan. Others are offered through a separate fertility vendor, a specialty pharmacy program, or a reimbursement arrangement.

When people refer to IVF benefits, they’re usually referring to coverage for in vitro fertilization, but fertility benefits can include much more than IVF.

What’s usually included under fertility benefits?

Fertility benefits vary widely by plan, but they typically fall into four categories.

1) Fertility testing and diagnosis

This may include:

• Specialist visits (reproductive endocrinologist consults)
• Bloodwork and hormone panels
• Ultrasounds and imaging
• Semen analysis
• Diagnostic procedures like hysterosalpingograms (HSG)

Many states that have fertility laws focus first on diagnostic coverage, even when IVF is not required.

2) Fertility medications

Fertility medications can be a major cost driver. Coverage may include:

• Ovulation induction medications
• Injectable hormones
• Trigger shots
• Medications used in IVF cycles

Plans may cover fertility medications even when they don’t cover IVF procedures.

3) Fertility treatment procedures

This is the part most people mean when they ask: what insurance covers IVF?

Treatment may include:

• Timed intercourse cycles
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Embryo transfer
• Procedures tied to IVF, such as egg retrieval

Some state mandates require IVF coverage explicitly. Others require infertility treatment more broadly, which may or may not include IVF depending on how the law is written.

4) Fertility preservation

Fertility preservation typically includes:

• Egg freezing
• Sperm freezing
• Embryo freezing
• Storage (sometimes)

Some states have mandates specifically for fertility preservation when medically necessary, such as for people undergoing cancer treatment or other care that may impact fertility (iatrogenic infertility).

What insurance covers IVF (and why it depends on your plan)

There isn’t a single answer to what insurance covers IVF.

Even within the same state, two people can have completely different fertility coverage depending on whether they’re on:

• A fully insured plan purchased from a carrier (often subject to state mandates)
• A self-funded employer plan (usually not subject to state mandates)
• A public program or marketplace plan (rules vary by state and carrier)

A quick note for HR and benefits leaders

Most state fertility coverage laws apply to fully insured health plans. If your company is self-funded, the state mandate may not apply, even if employees live in that state.

That doesn’t mean you can’t offer IVF benefits, it just means you may not be legally required to.

How state fertility mandates work

States generally take one of four approaches:

1) No mandate

The state does not require insurers to cover infertility diagnosis or treatment.

2) Mandate to cover

The state requires certain insurance plans to cover infertility services. Some states require IVF coverage specifically, while others require coverage for diagnosis and treatment but allow carriers to define scope.

3) Mandate to offer

The state requires insurers to offer infertility coverage, but employers can choose whether to buy it.

4) Limited mandate

The state requires coverage for only a narrow set of services, such as diagnosis only or fertility preservation for medically necessary cases.

IVF legality vs. IVF coverage

IVF and other fertility treatments remain legal in all 50 U.S. states, but access can still be affected by legal uncertainty, liability concerns, and a patchwork of insurance coverage rules. For example, a 2024 Alabama Supreme Court decision briefly disrupted IVF services by classifying frozen embryos as “children,” though the state later passed protections to support continued access. Unlike abortion laws, no state currently bans fertility treatments outright.

Fertility benefits by state: A–Z guide to mandates

Below is an A–Z list of state fertility insurance mandates. For each state, we include:

• Whether a mandate exists
• What types of plans are impacted
• What coverage is required (diagnosis, medications, IUI, IVF, preservation)
• Any major limitations to be aware of
• A practical takeaway for HR teams

Important note: This guide is for informational purposes only and does not constitute legal advice. Coverage rules can change, and plan interpretation can vary by carrier.

Alabama

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Alaska

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Arizona

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Arkansas

• Mandate status: Mandate to cover infertility treatment (including IVF in certain cases)
• Plans impacted: Fully insured plans subject to state insurance law
• Coverage required: Infertility diagnosis and treatment; IVF coverage required with conditions
• Notable limits: May include requirements to try other treatments first and/or lifetime maximums
• HR takeaway: If you’re fully insured in Arkansas, confirm the carrier’s IVF coverage criteria and limitations

California

• Mandate status: Mandate to cover infertility services, with IVF coverage expanding for certain plans
• Plans impacted: Fully insured plans subject to California insurance law (self-funded plans generally exempt)
• Coverage required: Infertility diagnosis and treatment; IVF coverage depends on plan type and effective date
• Notable limits: Implementation details may vary as guidance is issued
• HR takeaway: If you’re fully insured in California, confirm whether your carrier is applying the IVF mandate and when

Colorado

• Mandate status: Mandate to cover infertility diagnosis and treatment, including IVF
• Plans impacted: Fully insured plans subject to state insurance law
• Coverage required: Diagnosis, medications, and infertility treatment; IVF included
• Notable limits: May include retrieval and transfer limits
• HR takeaway: Colorado is one of the more comprehensive states; confirm how the carrier defines cycles and prior authorization

Connecticut

• Mandate status: Mandate to cover infertility diagnosis and treatment, including IVF
• Plans impacted: Fully insured plans subject to state insurance law
• Coverage required: Diagnosis, medications, infertility treatment; IVF included
• Notable limits: May include age and cycle limits
• HR takeaway: If you’re fully insured, review the cycle caps and medication coverage rules

Delaware

• Mandate status: Mandate to cover infertility services, including IVF
• Plans impacted: Fully insured plans subject to state insurance law
• Coverage required: Diagnosis, treatment, IVF; fertility preservation may be included
• Notable limits: May include age and cycle limits
• HR takeaway: Confirm whether fertility preservation and storage are included under your carrier’s interpretation

Florida

• Mandate status: Limited mandate (primarily for state employee plans)
• Plans impacted: Limited scope; most fully insured plans not required
• Coverage required: Varies
• Notable limits: State-specific and plan-specific
• HR takeaway: Most Florida employers will need to add fertility benefits voluntarily if they want IVF benefits

Georgia

• Mandate status: Limited mandate (fertility preservation for medically necessary cases)
• Plans impacted: Fully insured plans subject to state law
• Coverage required: Fertility preservation for iatrogenic infertility (in some cases)
• Notable limits: Storage and duration limits may apply
• HR takeaway: Georgia does not generally require IVF coverage; employers often need to add IVF benefits intentionally

Hawaii

• Mandate status: Mandate to cover some infertility services; may include IVF coverage for qualifying couples under specific conditions.
• Plans impacted: State-regulated fully insured plans
• Coverage required: At least one IVF cycle under long-standing fertility coverage requirements in Hawaii law.
• Notable limits: May have eligibility prerequisites (e.g., documented infertility period) and conditions on use of spouse’s sperm.
• HR takeaway: Confirm how your carrier interprets eligibility rules and whether IVF is covered under your plan design.

Idaho

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to provide fertility benefits through plan design or vendor partnerships.

Illinois

• Mandate status: Mandate to cover infertility treatment, including IVF under qualifying group markets
• Plans impacted: Fully insured group plans (certain size requirements may apply)
• Coverage required: Diagnosis and treatment, including IVF cycles (law expands eligibility to include same-sex couples and unmarried individuals).
• Notable limits: May require attempts with less invasive treatments first; cycle caps determined by statute/plan.
• HR takeaway: Check carrier interpretation of cycles and prerequisites for coverage.

Indiana

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider whether to voluntarily offer coverage.

Iowa

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider whether to voluntarily offer coverage.

Kansas

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider whether to voluntarily offer coverage.

Kentucky

• Mandate status: Limited mandate (fertility preservation for iatrogenic infertility)
• Plans impacted: Certain fully insured plans subject to state law
• Coverage required: Fertility preservation services and storage for medically necessary cases
• Notable limits: Self-insured and smaller groups may be exempt; coverage usually limited to one year storage
• HR takeaway: IVF and broader infertility treatment aren’t required by state law in Kentucky.

Louisiana

• Mandate status: No general fertility treatment mandate; protections for access
• Plans impacted: N/A for fertility coverage specifically
• Coverage required: Not mandated by state law
• Notable limits: Access protections are evolving but do not require carriers to include fertility benefits
• HR takeaway: Employers in Louisiana should plan fertility benefits voluntarily if coverage is a priority.

Maine

• Mandate status: Mandate to cover infertility care, including IVF and preservation
• Plans impacted: Fully insured plans
• Coverage required: Diagnosis, treatment, IVF, and fertility preservation with inclusive eligibility criteria
• Notable limits: Law is among the more comprehensive state mandates.
• HR takeaway: Review carrier interpretations of cycle and eligibility requirements.

Maryland

• Mandate status: Mandate to cover infertility treatment and IVF
• Plans impacted: Fully insured plans subject to Maryland law
• Coverage required: Diagnosis, treatment, IVF, and fertility preservation; lifetime benefit caps may apply
• Notable limits: Non-comprehensive in small groups and religious exemptions apply
• HR takeaway: Confirm how carriers structure cycles and caps.

Massachusetts

• Mandate status: Mandate to cover infertility care, broadly defined
• Plans impacted: Fully insured plans that include pregnancy benefits
• Coverage required: Diagnosis and treatment (including IVF and related services) with inclusive definitions and without cycle limits in many cases
• Notable limits: Carrier clinical guidelines can still set medical necessity criteria
• HR takeaway: Among the more comprehensive states; verify plan specifics.

Michigan

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

Minnesota

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

Mississippi

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

Missouri

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

Montana

• Mandate status: Mandate to cover some infertility services (including IVF in many implementations)
• Plans impacted: Fully insured plans
• Coverage required: Diagnosis and treatment including IVF coverage in many plan types
• Notable limits: Specific structural details vary by carrier and plan type
• HR takeaway: Confirm carrier interpretation and whether IVF is folded into the infertility coverage law.

Nebraska

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

Nevada

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

New Hampshire

• Mandate status: Mandate to cover infertility and IVF
• Plans impacted: Fully insured plans
• Coverage required: Diagnosis, treatment, IVF, and fertility preservation
• Notable limits: Law is comprehensive; implementation specifics vary
• HR takeaway: Confirm carrier interpretation of coverage details.

New Jersey

• Mandate status: Mandate to cover infertility, including IVF
• Plans impacted: Fully insured plans
• Coverage required: Diagnosis, treatment, IVF, and fertility preservation
• Notable limits: May include age or eligibility prerequisites
• HR takeaway: Review carrier interpretation of fertility benefit scope.

New Mexico

• Mandate status: No state fertility insurance mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers should consider voluntary benefit design.

New York

• Mandate status: Mandate to cover infertility and IVF
• Plans impacted: Fully insured plans
• Coverage required: Diagnosis, treatment, IVF, and fertility preservation
• Notable limits: Some markets have age/eligibility rules; large group mandates may phase in over time
• HR takeaway: One of the more comprehensive states; confirm plan design specifics.

North Carolina

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

North Dakota

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Ohio

• Mandate status: Limited mandate (infertility coverage requirement applies to some HMOs)
• Plans impacted: Some state-regulated HMO plans
• Coverage required: Infertility services (scope is limited and does not function like a full IVF mandate)
• Notable limits: Limited applicability and coverage scope
• HR takeaway: Most Ohio employers will need to add fertility benefits voluntarily if they want IVF benefits

Oklahoma

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Oregon

• Mandate status: Limited mandate (coverage requirements exist for certain public plans)
• Plans impacted: Limited scope (not a broad private-market mandate)
• Coverage required: Some infertility services depending on plan type
• Notable limits: Not a general IVF mandate for fully insured employer plans
• HR takeaway: Most employers in Oregon should not assume IVF coverage is required by state law

Pennsylvania

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Rhode Island

• Mandate status: Mandate to cover infertility diagnosis and treatment, including IVF
• Plans impacted: State-regulated fully insured plans
• Coverage required: Infertility services, including IVF
• Notable limits: Cycle limits and medical necessity criteria may apply
• HR takeaway: If you’re fully insured in Rhode Island, confirm how your carrier defines covered IVF cycles and related services

South Carolina

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

South Dakota

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Tennessee

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Texas

• Mandate status: Mandate to offer infertility coverage (not a mandate to cover)
• Plans impacted: State-regulated fully insured plans
• Coverage required: Coverage must be made available by insurers, but employers can choose whether to purchase it
• Notable limits: Benefit scope depends on the policy selected
• HR takeaway: If you’re fully insured in Texas, confirm whether your plan elected infertility coverage (it may not be included by default)

Utah

• Mandate status: Mandate to cover infertility treatment (scope varies by plan type)
• Plans impacted: State-regulated fully insured plans
• Coverage required: Infertility services (coverage may not equal a comprehensive IVF mandate)
• Notable limits: Details vary by carrier interpretation and plan type
• HR takeaway: Confirm with your carrier what infertility treatment is required under Utah law, and whether IVF is included

Vermont

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Virginia

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Washington

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Washington, D.C.

• Mandate status: Mandate to cover infertility diagnosis, treatment, IVF, and fertility preservation beginning January 1, 2025
• Plans impacted: State-regulated fully insured individual, small group, and large group health plans (self-insured plans may opt in)
• Coverage required: Diagnosis and treatment of infertility, including in vitro fertilization (IVF) with at least three complete oocyte retrievals and unlimited embryo transfers following ASRM guidance, plus standard fertility preservation services
• Notable limits: Coverage must be provided without discriminatory limits based on arbitrary factors (age, number of attempts, dollar limits, etc.), and cost sharing must be consistent with other medical benefits
• HR takeaway: If you offer fully insured plans written in the District, D.C. requires broad infertility and IVF coverage starting in 2025. Confirm benefit design and carrier compliance ahead of implementation.

West Virginia

• Mandate status: Mandate to cover infertility services
• Plans impacted: State-regulated fully insured plans
• Coverage required: Infertility services (scope varies and may not function as a broad IVF mandate)
• Notable limits: Carrier interpretation and medical necessity criteria may apply
• HR takeaway: If you’re fully insured in West Virginia, confirm what infertility services your plan must include under the mandate

Wisconsin

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

Wyoming

• Mandate status: No state fertility insurance coverage mandate
• Plans impacted: N/A
• Coverage required: Not applicable
• Notable limits: Not applicable
• HR takeaway: Employers can still choose to offer fertility benefits, including IVF benefits, through plan design or a fertility vendor

FAQ: Fertility benefits and IVF coverage

What insurance covers IVF?

Some fully insured plans cover IVF because of state mandates, but many plans cover IVF only if the employer chooses to include it. Self-funded plans are usually not required to follow state mandates.

Which states require IVF coverage?

A growing number of states require some level of IVF coverage for certain fully insured plans. However, the details vary widely and may include cycle limits, eligibility rules, or employer size thresholds.

Do state fertility mandates apply to self-funded plans?

Usually not. Most self-funded plans are regulated under federal ERISA rules rather than state insurance mandates.

Can employers offer fertility benefits even if their state has no mandate?

Yes. Many employers offer fertility benefits voluntarily, either through their medical plan, a fertility vendor, or a reimbursement approach.

How Nava helps employers navigate fertility benefits

Fertility benefits are one of the highest-impact, highest-complexity areas of health plan design.

Nava helps employers:

• Understand what their current medical plan covers
• Evaluate fertility benefit options (carrier vs. vendor)
• Build inclusive fertility and family-building programs
• Communicate benefits clearly to employees

Sources: Resolve: The National Infertility Association, KFF