Short answer: It depends on your state and plan. As of late 2025, 25 states plus Washington, D.C. require some fertility coverage, and 15 of those include in vitro fertilization (IVF). Coverage is not an ACA essential health benefit, so plans not subject to a mandate may exclude it.
Fertility treatment is not one of the federal essential health benefits, so whether your plan covers it largely depends on state law and the specific plan. As of December 2025, 25 states and the District of Columbia had passed laws requiring some form of fertility coverage, and 15 of those mandates include IVF; many also require coverage to preserve fertility before treatments like chemotherapy.
The details vary widely. State mandates can apply only to certain plan types (for example, large-group or fully insured plans), and may set conditions such as an infertility diagnosis, age limits, or a cap on the number of treatment cycles. Self-funded employer plans are generally governed by federal ERISA rather than state mandates, so coverage there depends on the employer’s plan design.
If fertility care matters to you, check your state’s mandate, read your plan’s benefits summary, and confirm what is covered (diagnosis, medications, IUI, IVF, fertility preservation) and any limits. A growing number of employers offer fertility benefits voluntarily even where no mandate applies.