ACA Plans Must Cover IVF and Fertility Care: New Bill Mandates Coverage for 3 Egg Retrievals, No Infertility Diagnosis Needed

The Health Coverage for IVF Act of 2025 is trying to fix one of the biggest financial hurdles for family planning: the cost of fertility treatments. Simply put, this bill mandates that insurance plans sold on the individual and small group markets under the Affordable Care Act (ACA) must now treat fertility treatment and care as an Essential Health Benefit (EHB). This means coverage for services like in vitro fertilization (IVF), egg/sperm preservation, genetic testing of embryos, and fertility medications must be included in your plan, not just offered as an expensive add-on. This change applies to plan years beginning one year after the law is enacted.

The New Definition of Coverage: IVF and Beyond

This isn't just a vague promise of coverage; the bill is highly specific about what insurers must cover. For those pursuing IVF, the law requires coverage for at least three complete egg retrievals and an unlimited number of embryo transfers resulting from those retrievals. It also covers preservation services (freezing eggs, sperm, or embryos) and artificial insemination (IUI). This is a massive shift. Think about the average person who currently spends $20,000 or more per IVF cycle out-of-pocket—this bill attempts to bring that cost in line with standard medical procedures.

No Diagnosis, No Problem: Removing the Gatekeeper

One of the most significant changes for consumers is the removal of the requirement for an infertility diagnosis. Historically, insurance companies could deny coverage until a person or couple had officially been diagnosed as infertile, often after a year or more of trying to conceive. Under this bill, insurance issuers in the individual and small group markets cannot deny coverage for fertility treatment and care simply because a formal diagnosis is missing. This is crucial for single parents by choice, LGBTQ+ couples, or individuals undergoing cancer treatment who need to preserve their fertility before treatment begins.

Fair Play Rules for Insurers

If you’ve ever tried to use an insurance benefit that was technically covered but had sky-high copays or impossible prior authorization rules, you know how hollow that coverage can feel. This bill addresses that by requiring insurance plans to treat fertility benefits the same as they treat standard medical and surgical benefits. This means the financial rules—deductibles, copays, and coinsurance—applied to fertility care cannot be stricter than what applies to most other medical services. Likewise, treatment limitations, like visit caps or prior authorization hurdles, must be no more restrictive than those applied to the majority of other covered procedures. For busy working people, this means less time fighting with insurance companies over arbitrary rules.

The Catch: Increased Oversight and Potential Costs

While the benefits for families are clear, there are always trade-offs when mandating new coverage. First, insurance companies will face increased financial liability, which could translate into higher premiums for enrollees in the individual and small group markets, as mandated coverage costs are generally passed down. Second, the bill creates a massive new layer of oversight. For the first five years, insurers using utilization management tools (like step therapy or prior authorization) for fertility care must analyze and report this usage to the government. The Comptroller General will then issue annual public reports to Congress, essentially grading insurers on their compliance with the new fairness rules. This is good for transparency, but it adds administrative complexity and cost to the system. While the bill aims to ensure fair treatment, the sheer volume of mandated coverage means someone has to pay the bill, and that will likely be reflected in overall plan pricing.