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In US, Obamacare includes IVF Coverage

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#1 brushstorm

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Posted 16 January 2016 - 04:15 PM

Sorry CA folks for being a bit off topic for the forum, but for US folks this is really important, life-changing news - I've just discovered that in a few states, IVF is covered by "Obamacare" / plans:


Here are some states that cover it, at least to some degree*:





New Jersey

Rhode Island

Texas (group coverage only)


In Illinois, I found plans that cover up to 6 retrievals in a lifetime, and others that cover up to 4 in a year. Also, I found out that even if you have an employer plan available to you, you still have the option to get healthcare at You can either decline your company plan and just get the national plan, or you can have both - so even if you're not at open enrollment for your company plan right now, you still can sign on for one of these plans - in Illinois for 2016, if I'm understanding the documentation correctly, it looks like there's one plan (Harken Health Care Gold 2) where premiums + max out of pocket for the year is < $7000, and 6 cycles are covered with no copay, and fertility drugs are also covered (with copay of $350/prescription)!!! The open enrollment ends for 2016 Jan 31, so you need to move fast if you want to sign up now.

#2 mouse


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Posted 16 January 2016 - 06:14 PM

I suspect this will apply only in the states where insurance plans are already mandated to cover IVF, specifically:
New Jersey
New York
Rhode Island
West Virginia
(The description you've noted reflects the mandate for Illinois). Keep in mind too, that each state may use different definitions of infertility, have differing concepts of what, exactly, should be covered (and by how much) and that there are specific requirements set out in order to qualify.
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