Is In Vitro Covered by ObamaCare?
In Vitro Fertilization is a procedure many Americans select to help them have children. Most are unaware if this procedure is covered by ObamaCare. While maternity care must be covered by essential health benefits required by the Affordable Care Act, most states do not cover In Vitro Fertilization (IVF).
UPDATED: August 1, 2016
Is In Vitro Covered by Essential Health Benefits?
In Vitro is not covered by the fed’s essential health benefits; however a rare few states may require that non-religious employers offer coverage for IVF, and even fewer states require that individual plans offer IVF.
Does My State Cover IVF?
Most likely not! While approximately 11% of women between the ages of 15-45 are afflicted with fertility issues according to the Centers for Disease Control and Prevention, it is unlikely that your state will require IVF coverage is available. If it is offered in your state it is usually offered by your employer, not by individual plans.
With that said, not all employees will cover IVF, even if you live in a state that does require it. Here are two of the exemptions: employers who have over 1000 employees are considered self-insured, and can choose to opt out of IVF coverage, as well as, religious employers.
Does IVF Kick in Immediately in States that Require It?
Depends on the state. Some states, like Texas require that a couple has tried for five years to get pregnant with no success, while other states have more lenient policies. It is important that you understand how your health benefits are covered before enrolling.
Comments and Questions
Click to leave a CommentComment from Desiray on July 07, 2016
I live and work in Texas but my company is based in Kentucky and covered by Aetna insurance of Kentucky. What law do they have to follow? No coverage because the insurance and company is based in Kentucky? Or coverage because the job is in Texas?
Thanks.
MEDICOVERAGE AGENT RESPONSE
Desiray,
Most likely it would follow the Kentucky rule, but you will want to contact your company’s HR to confirm your coverage. Best of luck!
-Amy from http://www.medicoverage.com/
Comment from Kelly on June 15, 2016
I live in Illinois where IVF coverage is mandated but my employer doesn’t allow to cover it since employer is ‘Catholic.’ Therefore my insurance doesn’t not cover my needs (IVF is needed secondary to history of other medical problems). Can I purchase a plan through the marketplace and drop my employers insurance? Thanks!
MEDICOVERAGE AGENT RESPONSE
Kelly,
For you to leave your job-based insurance outside of Obamacare Open Enrollment, your insurance would have to be more than 9.5% of your income. If that is your case, you could look into a plan in your area that offers IVF. For further help, call one of our Medicoverage licensed independent insurance agents at 800-930-7956.
-Amy from http://www.medicoverage.com/
Comment from Stephanie on April 22, 2016
Thank you for the valuable information. I am unclear about Texas (group coverage only). Is Obamacare considered group coverage?
MEDICOVERAGE AGENT RESPONSE
Stephanie,
Group coverage is purchased through a large employer (more than 50 employees). So, no, Obamacare is not considered group coverage. If you need he-lp finding a health plan, call one of our licensed independent insurance agents at 800-930-7956.
-Chris from http://www.medicoverage.com/
Comment from Gabriela on April 13, 2016
Does IVF is cover wit obama care in Florida?
MEDICOVERAGE AGENT RESPONSE
Gabriela,
Unfortunately, Florida does not offer IVF.
-Amy from http://www.medicoverage.com/
Comment from AnJanette on February 24, 2016
What percentage does the affordable act covers for the IVF treatment. How can I leverage and integrate all the medical benefits?
MEDICOVERAGE AGENT RESPONSE
AnJanette,
The Affordable Care Act does not provide coverage for IVF. Some states do offer coverage, but many times the health benefits are only offered through group coverage.
-Amy from http://www.medicoverage.com/
Comment from Gabriel on January 26, 2016
Does Pennsylvania cover In Vitro, if yes what %, thanks.
MEDICOVERAGE AGENT RESPONSE
Gabriel,
As of now Pennsylvania does not cover In Vitro Fertilization.
-Michelle from http://www.medicoverage.com/
Comment from Lori on January 21, 2016
I understand IVF is not a requirement in the State of Iowa; but do you know of any insurance carriers who include this benefit? Thank you!
MEDICOVERAGE AGENT RESPONSE
Lori,
If the state does not require IVF, it is unlikely that an insurance company would cover it. Sorry we don’t have better news.
-Michelle from http://www.medicoverage.com/
Comment from Mahsa on January 20, 2016
I am 31, can not get pregnant, for 9 years Married, because of (POF) live in Texas!
I keep looking around to find best way/help/insurance for treatment. I need to ask you how ” Texas (group coverage only) ” works and how I can get into that? I do not know where I should go to look these steps up. I have Obamacare
MEDICOVERAGE AGENT RESPONSE
Mahsa,
Group coverage is offered through an employer. You would need to obtain a position with a company (usually a large employer) that is not exempt for religious reasons, and then research how their IVF coverage works. Best of luck!
-Amy from http://www.medicoverage.com/
Comment from Sarah on January 16, 2016
I live in CT but have my insurance through my husbands job in NYC. Both NY and CT have state mandates…but which one am I eligible for?
MEDICOVERAGE AGENT RESPONSE
Sarah,
Not totally sure which mandate you are asking about. If you’re wondering if you have IVF coverage, then you’ll want to talk to husband’s insurer. If you’re looking for new individual coverage, you would enroll in Connecticut. Please leave another comment if we haven’t answered your question.
-Chris from http://www.medicoverage.com/
Comment from D'lynn Green on January 16, 2016
I live in Virginia, what are choice’s for fertility treatments?
MEDICOVERAGE AGENT RESPONSE
D’lynn,
As far as we can tell, Virgina does not cover fertility treatments.
-Michelle from http://www.medicoverage.com/
Comment from Chris on January 09, 2016
I live in NY and am aware that NY does not require ivf coverage. I need aggressive treatment with either injectibles or injectibles with ivf. A big chunk of the cost appears to also be the treatment meds themselves. Are there plans in the marketplace that cover a good portion of treatment and meds beyond just basic treatment? Since these treatments are time sensitive, does NY have time requirements before utilizing these benefits or any other important limitations? Also, of the states that require ivf coverage, are there some that are more friendly or flexible than others? This is an incredibly frustrating experience.
Thank you.
MEDICOVERAGE AGENT RESPONSE
Chris,
We understand what a frustrating experience this can be. Each state has its own set rules, and many times if the state requires insurance to cover IVF, it can be only through group coverage (and some group insurance can exclude the coverage). All states that require IVF coverage do have varying waiting periods and requirements. As for New York, IVF treatment is excluded, as is gamete intrafallopian tube transfers and zygote intrafallopian tube transfers. However, it appears that certain medications for infertility are covered by certain insurers. Please call 800-930-7956 for further help.
-Jacima from http://www.medicoverage.com/
Comment from stacey dash on January 07, 2016
I live in Arkansas and I was wondering if the ObamaCare covers IVF
MEDICOVERAGE AGENT RESPONSE
Stacey,
Arkansas insurance companies do offer IVF. It is not specified if only group insurance covers IVF, or if individual insurance covers it, as well. Please call 800-930-7956 to help you find a plan in your area.
-Amy from http://www.medicoverage.com/
Comment from Sahily on January 05, 2016
I live in milwaukee WI I will love to know if it is cover in here, or they plan to add it soon. If not what can I do, in terms of getting one that does cover it?
<div class=“two”>Sahily,
I don’t have any good news for you. There are very few states that offer In Vitro, and if they do most are offered through large groups. Unfortunately, Wisconsin is not a state that offers IVF. Wish we could help you more.
-Michelle from https://www.senior65.com/</div>
Comment from Mary Prato on January 02, 2016
I live in Long Island NY. Is Obama Care going to change its coverage plan this year and include NY as one of the states that cover IVF?
MEDICOVERAGE AGENT RESPONSE
Mary,
As of now, New York, Louisiana, and California has laws that specifically exclude IVF coverage. Obamacare cannot change this, unless it was to make it mandatory that all states cover infertility treatment. You may want to contact your representative in NY and let them know you think IVF should be covered.
-Amy from http://www.medicoverage.com/
Comment from Jerri on January 02, 2016
I would like to know if ObamaCare covers IVF in Kansas?
MEDICOVERAGE AGENT RESPONSE
Jerri,
The state of Kansas does not include IVF coverage in their insurance plans. It looks like there is online petition to have the state change this, but as of now it is not covered. Best of luck.
-Michelle from http://www.medicoverage.com/
Comment from Angela on December 11, 2015
What are my options in Michigan? Where do I find such information? I am 36 and ready for a child as is my partner!
MEDICOVERAGE AGENT RESPONSE
Angela,
Thank you for your question. It appears that Michigan does not cover IVF. Click here if you would like a Health insurance quote for Michigan.
-Michelle from http://www.medicoverage.com/
Comment from ilhame on November 30, 2015
I live in Texas, and I have Obama care Ambetter Superior Health Plan. What I need to do to get benefits.
MEDICOVERAGE AGENT RESPONSE
Ilhame,
You’ll find your provider’s contact information on the back of your card. They should be able to explain to you over the phone your benefits or point you in the right direction on their website. Hope this helps!
-Amy from http://www.medicoverage.com/
Comment from djaware namorou on November 18, 2015
I live in Georgia and I would like to know if ObamaCare covers IVF in this state.
MEDICOVERAGE AGENT RESPONSE
Djaware,
Unfortunately, it appears that there are no plans that offer IVF in Georgia. If we learned differently, we will update this comment.
-Amy from http://www.medicoverage.com/
Comment from Paramjit Kaur on August 31, 2015
i have Aetna just trying to find out that if cover ivf
MEDICOVERAGE AGENT RESPONSE
Paramjit,
As each state and carrier has its own rules, you will want to contact the number on the back of your Aetna card to see if your plan covers IVF in your state.
-Eric from http://www.medicoverage.com/