Fertility Coverage Mandate Expands to Private Insurance, Medicare, and VA: IVF Access Set to Skyrocket

The newly proposed Access to Fertility Treatment and Care Act is a massive overhaul of how fertility services are covered in the U.S., mandating comprehensive coverage across nearly every major public and private health plan. Essentially, if your health plan—whether it’s employer-sponsored, individual market, Medicare, Medicaid, or even TRICARE—already covers obstetrical services (think pregnancy and childbirth), it must now also cover a broad range of fertility treatments.

This isn't just about IVF. The bill defines “fertility treatment” broadly to include everything from egg/sperm preservation and artificial insemination (IUI) to the full suite of assisted reproductive technologies (IVF), genetic testing on embryos, and all necessary medications (Sec. 2). Crucially, the bill specifies that you don't need a formal diagnosis of infertility to get coverage, as long as the treatment is deemed clinically appropriate by a qualified facility.

The End of the Fertility Surcharge

For most people, the biggest financial hurdle in fertility treatment is the cost-sharing—the deductibles, copays, and coinsurance that make a single IVF cycle cost more than a down payment on a car. This bill tackles that head-on. Under the new rules for private insurance, your plan cannot charge you higher deductibles or coinsurance for fertility treatment than it charges for standard medical services (Sec. 2). If your plan has any limitations on fertility care, those limits must be more favorable to you than the limits on other medical services.

Think of it this way: If your copay for a routine specialist visit is $50, your copay for a fertility specialist visit can’t be $150. This provision aims to stop insurers from treating fertility care as a luxury item and instead treat it like any other necessary medical service.

Government Programs Get a Major Upgrade

This legislation isn't just aimed at the private sector; it mandates coverage across all major federal programs, which is huge for millions of people.

• Medicare (Starting Jan. 1, 2026): The bill adds fertility treatment to the list of covered Medicare services. Even better, it waives the standard Medicare deductible for these services and mandates 100% coverage of the cost based on Medicare’s fee schedule (Sec. 7). This means zero out-of-pocket costs for fertility treatment for Medicare beneficiaries.
• Medicaid (Starting Oct. 1, 2026): State Medicaid plans will be required to cover fertility treatment, following the same comprehensive rules applied to private insurance (Sec. 6). This is a massive win for low-income families seeking treatment.
• VA and TRICARE: The bill mandates that TRICARE plans covering obstetrics must cover fertility treatment (Sec. 4). For veterans, the VA is required to establish a brand-new benefit to provide fertility treatment services to veterans and their spouses or partners who apply jointly (Sec. 5). The VA has 18 months to set up the rules for this benefit.

The Cost and the Catch

While this bill is a game-changer for access, it’s important to look at who bears the cost. Mandating comprehensive coverage across the board means that insurance companies, employers offering self-funded plans, and state Medicaid programs will face significantly increased costs. For private plans, this usually translates into higher premiums for everyone, even those who don't need fertility services.

Also, while the bill prevents insurers from charging patients more for fertility care, it explicitly allows them to continue negotiating the price and type of reimbursement paid to providers (Sec. 2). This means an insurer could potentially use low reimbursement rates to limit the number of fertility clinics willing to be in-network, which could create access bottlenecks even with mandated coverage. The bill also gives the Secretary of Health and Human Services broad authority to define “whatever else” relates to fertility care, which could lead to future regulatory battles over what exactly is covered (Sec. 2).

Overall, this Act is a sweeping move to treat fertility care as essential healthcare, removing financial barriers for millions of Americans across the public and private sectors, though the cost of this mandate will eventually be distributed among policyholders, taxpayers, and employers.