Does your health plan cover IVF? How to check during open enrollment

Open enrollment is a chance to review IVF benefits before choosing a health plan. For 2027 coverage, HealthCare.gov open enrollment runs November 1, 2026 to January 15, 2027. December 15 is the deadline for January 1 coverage. Special enrollment periods may apply outside these dates; state marketplaces and employer plans can set different windows.

The 30-second version

Step 1: Find out who actually pays the bills

Ask HR whether your plan is fully insured or self-funded (self-insured). A fully insured plan is one an insurance company pays for - state IVF laws may apply, depending on the state, policy and employer size. A self-funded plan is one your employer pays for itself, with an insurer only administering it - state IVF mandates do not reach these plans. You cannot tell from your insurance card: the same insurer's logo appears on both. Some self-funded employers add fertility benefits anyway, so ask either way.

Step 2: Read the plan documents, not the summary

Get the Evidence of Coverage or Summary Plan Description - the full legal document, not the brochure. Search it for "infertility", "IVF" and "assisted reproductive technology". Read the exclusions section too: a plan can mention IVF and still exclude the medications, the genetic testing, or everything after a dollar cap.

Step 3: Check your state's law

If your plan is fully insured, your state may require IVF coverage. Three states with strong, verified laws:

California (SB 729 / AB 116). Since January 1, 2026, state-regulated large-group plans (employers with more than 100 employees) must cover the diagnosis and treatment of infertility, including IVF with up to three completed egg retrievals and unlimited embryo transfers, for plans issued or renewed from that date. Small-group plans must offer infertility coverage; self-funded plans, individual-market plans (including Covered California) and Medi-Cal are not covered by the mandate; Religious-employer exceptions apply; CalPERS follows from July 1, 2027. Current law

Illinois (215 ILCS 5/356m). Since January 1, 2026, every fully insured group policy that includes pregnancy benefits - any employer size - must cover infertility diagnosis and treatment, including IVF and preimplantation genetic testing. The 2026 provision requires medically appropriate care and SART-member facilities; check your policy for authorization and treatment terms. Religious employers are exempt; self-funded plans are not insurance policies, so the mandate does not reach them. Statute text

New York. State-regulated large-group plans (more than 100 employees) must cover three IVF cycles and related drugs; individual and small-group policies must cover basic infertility treatment, including IUI. Self-funded plans are exempt. NY Department of Financial Services

The examples above are not a complete state-law list. Where a policy is issued matters, not only where you live. Ask the insurer which law applies to your specific policy.

Step 4: Ask, and write down the answers

Ask HR, the benefits portal, or the member-services number on your card: Is this plan fully insured or self-funded? Which state's law is it written under? Does it cover IVF, and how many retrievals or cycles? Are medications covered? Is there a lifetime dollar cap? Which clinics are in network? Is prior authorization required? Write down who you spoke to, when, and the reference number - coverage answers have a way of changing later.

Step 5: Price what is not covered

Deductibles, coinsurance, medications (a median $4,500 among 25 of 621 locations with published medication prices) and lifetime caps add up on top of any coverage. Compare with what clinics actually charge: what clinics in your state publish.

Common questions

Sources and method

Sources: the state laws and regulator guidance linked above; HealthCare.gov enrollment dates. Price medians use published range midpoints:175 of 621 US locations for IVF ($13,125),25 of 621 for medication ($4,500). Published packages differ; neither median is a complete bill. General information, not legal, medical or financial advice. Confirm your plan terms with the insurer.

Last updated: Oct 30, 2026