In early 2023, the Office of Personnel Management (OPM) addressed the need for better fertility treatment options within the Federal Employees Health Benefits (FEHB) plans. Starting in 2024, significant improvements will be mandated, expanding coverage to include specific fertility treatments.
Currently, all FEHB plans provide coverage for diagnosing and treating infertility. However, most plans do not cover assisted reproductive technologies (ART) and other fertility services. There are some exceptions to this. Currently, 20 states—Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah, and Virginia—have state mandates for some level of fertility coverage, often delivered through HMO plans. These typically include one to two artificial insemination procedures and occasionally cover fertility medications, but in vitro fertilization (IVF) is rarely covered.
Starting in 2024, all FEHB plans will include coverage for:
- Artificial insemination methods such as intrauterine (IUI), intracervical (ICI), and intravaginal (IVI) insemination
- Drugs associated with artificial insemination procedures
- The cost of IVF related drugs for up to three cycles per year
Although this expansion in fertility benefits marks progress, a significant portion of fertility costs will still be out-of-pocket. IVF cycles can cost between $15,000 and $30,000, with fertility drugs only accounting for 35% of the total cost.
Notably, several procedures are not required to be covered, including IVF itself, Embryo Transfer, Gamete Intrafallopian Transfer (GIFT), and Zygote Intrafallopian Transfer (ZIFT). The cost of donor sperm, donor egg, donor embryo, and cryopreservation are also not required to be covered.
When selecting an FEHB plan, individuals concerned with fertility treatments should carefully review the coverage details, what services and procedures are covered by a specific FEHB plan, cost sharing details, and whether the fertility benefits are provided before or after the deductible.