Fertility Care Mandate: New Bill Requires IVF Coverage, Caps Costs, and Expands Access to Veterans and Medicare

This bill, the Access to Fertility Treatment and Care Act, aims to fundamentally reshape who can access fertility services like IVF, egg freezing, and related medications—and how much they have to pay for it. The core of the legislation mandates that if a health plan covers obstetrical services (think maternity and childbirth care), it must also cover comprehensive fertility treatment, including assisted reproductive technology (IVF), genetic testing, and donation services (SEC. 2).

The New Rule for Your Health Plan

For most people with private insurance—whether through a large employer (Group Health Plan) or an individual policy—the biggest change is the coverage mandate. If your plan already covers you when you’re pregnant, it now has to cover you when you’re trying to get pregnant, even if you don't meet the traditional medical definition of infertility (SEC. 2). Crucially, the bill prohibits plans from imposing higher deductibles, copayments, or other cost-sharing for fertility treatment than they charge for basic medical or surgical services. This means no more facing a massive, separate deductible just for fertility procedures, which is a huge financial barrier for many working families (SEC. 2).

This isn't just about private insurance. The bill extends the same mandatory coverage to federal employees under the FEHB Program and to military families under TRICARE, ensuring that if their plan covers obstetrical care, it must cover fertility care with comparable cost-sharing (SEC. 3, SEC. 4).

Expanding the Safety Nets: Medicare and Medicaid

The legislation also tackles public health programs. For Medicare, starting January 1, 2026, fertility treatment is added as a covered service under Part B. Even better for seniors: Medicare will cover 100% of the cost for these treatments, and the standard Part B deductible won't apply (SEC. 7). This provision ensures that even older Americans or those with specific medical needs who rely on Medicare will have access to covered fertility care.

For state Medicaid programs, the bill mandates that starting October 1, 2026, states must include fertility treatment alongside family planning services. This is a massive shift, requiring state programs to comply with the same federal coverage standards applied to private insurance (SEC. 6). While this significantly expands access for low-income individuals, it does shift a substantial new financial burden onto state budgets, though states that need legislative changes get a short grace period.

A New Benefit for Veterans

Recognizing the unique challenges faced by military families, the bill establishes a brand new benefit through the VA. The Secretary of Veterans Affairs must now provide fertility treatment services to veterans and their spouses or partners, provided they apply together (SEC. 5). This moves fertility care from a discretionary or limited benefit to a mandatory service for those who served, though the VA has 18 months to finalize the rules before implementation.

The Real-World Impact and What to Watch For

This bill is a game-changer for access, but it's not without complexities. By mandating comprehensive coverage and requiring cost-sharing parity, it removes the immediate financial roadblock for millions of Americans who previously couldn't afford IVF. For instance, a couple needing IVF that typically costs $20,000 out-of-pocket might now only pay standard specialist copays and a fraction of the deductible.

However, this new mandate means increased costs for health insurance issuers and, likely, higher premiums for employers and employees. While the bill strictly prohibits plans from trying to discourage treatment or penalize providers, watch how insurance companies define "medically appropriate" care. Furthermore, coverage is contingent on the facility meeting standards set by a federal agency, which could create temporary access bottlenecks if facilities struggle to meet new regulations during the rollout (SEC. 2).

Overall, the bill’s effect is clear: if you have health insurance, your access to fertility care is about to get a whole lot better and more affordable, regardless of whether you work in the private sector, serve in the military, or rely on federal programs like Medicare or Medicaid.