State Insurance Mandates
22 states plus DC now have laws requiring insurance companies to cover some form of fertility treatment. But “mandate” doesn’t mean “everything is free”—coverage varies enormously.
| State | Mandate Type | IVF Covered? | Key Limits |
|---|---|---|---|
| Colorado | Cover | Yes | 3 egg retrievals, 3 transfers; up to $25K lifetime |
| Connecticut | Cover | Yes | Up to 2 cycles; age limit removed 2023 |
| Illinois | Cover | Yes | 4 egg retrievals; no age limit |
| Maryland | Cover | Yes | $100K lifetime max; includes IUI & IVF |
| Massachusetts | Cover | Yes | No cycle limits; most comprehensive |
| New Jersey | Cover | Yes | 4 egg retrievals; LGBTQ+ inclusive |
| New York | Cover | Yes | 3 cycles; large employer plans |
| California | Offer | No (IUI only) | Requires offer, not cover |
| Texas | Offer | Limited | IVF for married couples only, strict criteria |
Here’s the catch most people don’t know: state mandates only apply to state-regulated insurance plans. Most large employers (Fortune 500, tech companies, etc.) self-insure, meaning they fund their own health plans and are regulated by federal ERISA law, not state law. Self-insured plans are exempt from state fertility mandates. If your employer self-insures (most with 500+ employees do), the state mandate may not apply to you. Check whether your plan is “fully insured” or “self-insured” by calling the number on your insurance card.
Employer Fertility Benefits
The fastest-growing category of fertility coverage. Companies increasingly offer fertility benefits through platforms like Progyny, Carrot Fertility, Maven, and WINFertility. These benefits operate independently from insurance and can cover IVF, egg freezing, IUI, and sometimes surrogacy and adoption.
Typical coverage: $10,000–$50,000+ in lifetime fertility benefits. Some companies measure in “smart cycles” (Progyny) rather than dollar amounts, which is more favorable because a smart cycle covers the full treatment without dollar caps eating into coverage.
1. Search your benefits portal for “fertility,” “family building,” or “reproductive.” 2. Check for Progyny, Carrot, or Maven listed as benefit providers. 3. Ask HR directly—fertility benefits are often poorly publicized. 4. Call your insurance card number and ask specifically about “infertility treatment coverage” and “oocyte cryopreservation.”
Fertility Grants
Competitive but real. These organizations award grants for fertility treatment costs:
Awards grants for IVF, egg/sperm donation, surrogacy, and embryo donation. Open to all family types. Competitive application; awards made quarterly.
For couples with financial need. Application includes financial disclosure. Annual deadline. Has awarded $1M+ since founding.
Open to couples with infertility diagnosis. Includes IVF, IUI, and adoption. Application opens annually.
Partners with fertility clinics to offer discounted or free fertility preservation for cancer patients. Not a cash grant—direct clinic discounts.
Monthly grants of varying amounts. Simple application. Open to all family structures.
HSA & FSA Tax Strategies
Fertility treatment qualifies as a medical expense under IRS rules. This creates meaningful tax savings opportunities:
- HSA (Health Savings Account): Contribute pre-tax dollars ($4,150 individual / $8,300 family for 2025). Use for any fertility expense. Triple tax advantage: tax-deductible going in, grows tax-free, and withdrawals for medical expenses are tax-free. If you have a high-deductible plan, max your HSA before treatment.
- FSA (Flexible Spending Account): Contribute up to $3,200 pre-tax. Use-it-or-lose-it, so time your contributions to match planned treatment cycles. At a 30% effective tax rate, $3,200 in FSA saves roughly $960 in taxes.
- Medical expense deduction: If total medical expenses exceed 7.5% of your AGI, the excess is deductible. For a couple with $100K income and $25K in IVF costs, that’s $17,500 in deductions ($25K minus $7.5K threshold).
Fertility Loans & Payment Plans
| Option | Typical Terms | Best For |
|---|---|---|
| Clinic payment plans | 0% interest for 6–12 months | Short-term financing if you can pay within a year |
| CapexMD | Fertility-specific loans, competitive rates | Larger amounts ($10K+) with reasonable terms |
| Prosper Healthcare Lending | Fixed rates, terms up to 84 months | Spreading cost over longer period |
| LendingClub / SoFi | Personal loans, 7–15% APR typical | Good credit borrowers needing flexibility |
| 0% APR credit cards | 0% for 15–21 months intro | Bridging cost if you can pay off before promo ends |
| 401(k) loan | Borrow from yourself, repay with interest to yourself | Last resort; impacts retirement savings |
IVF Refund Programs (Shared Risk)
Some clinics and Attain Fertility (ARC) offer “shared risk” programs: you pay a higher upfront fee (typically $20,000–$35,000) that covers multiple IVF cycles (usually 3–6). If you don’t have a baby, you get 70–100% of your money back.
The economics: these programs are priced so the clinic wins on average (they keep the premium for patients who succeed on cycle 1). But for patients facing uncertain outcomes, the risk reduction can be worth the premium. You’re essentially buying insurance on top of treatment.
Read the fine print carefully. Key questions: What counts as a “cycle”? What if you produce no embryos—does that count? What’s excluded (medications, PGT, FET are often extra)? What are the age/AMH cutoffs for eligibility? How is the refund calculated? Some programs define success as “clinical pregnancy” (heartbeat) rather than live birth.
10 More Ways to Reduce Costs
- Get 3+ clinic quotes. Same-city pricing varies by $5,000+ for the same treatment.
- Shop specialty pharmacies for meds. MDR, Freedom Fertility, Alto—prices vary $1,000+ for identical medications.
- Ask about compassionate care programs. EMD Serono (Gonal-F), Ferring (Menopur), and others offer discounts for patients without coverage.
- Consider treatment abroad. Colombia, Spain, Czech Republic offer IVF at 50–70% of US prices. See our IVF cost guide.
- Look into clinical trials. Fertility clinics sometimes offer free or discounted cycles as part of research studies.
- Ask about mini-IVF. Lower medication costs, $5K–$8K per cycle. See our mini-IVF guide.
- Time your FSA enrollment. Enroll for max contribution the year you plan treatment.
- Use donated/leftover medications. FertilityFriends, r/IVF, and clinic bulletin boards connect patients with unused meds.
- Negotiate with your clinic. Pay-in-full discounts (5–10%) are common but rarely advertised.
- Fundraise transparently. GoFundMe and similar platforms are increasingly used for fertility treatment. No shame in it.
FAQ
Financial Disclaimer
This content is for informational purposes only. Tax implications vary by situation—consult a tax professional. Loan terms and grant availability change; verify current details before applying.
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