Does Insurance Cover IVF in NY? Mandate, Cycles, and Denials

Whether insurance covers IVF in New York depends entirely on what kind of health plan you have. State law requires large group fully insured plans to cover up to three IVF cycles per lifetime, but individual plans, small group plans, and self-funded employer plans are not covered by that mandate. Medicaid, the Essential Plan, and Medicare are also excluded.¹²

Which Plans Must Cover IVF

The IVF mandate, which took effect January 1, 2020, applies only to large group health insurance policies. Those are fully insured plans offered by employers with more than 100 employees. On those plans, insurers must cover three cycles of IVF for the treatment of infertility, along with related prescription drugs and medically necessary storage of eggs or embryos.¹

Individual and small group plans do not have to cover IVF. They must cover diagnosis and treatment of correctable medical conditions that cause infertility, plus basic treatments like intrauterine insemination, but the expensive step (IVF itself) is not required.²

The largest gap is self-insured employer plans, often called self-funded or ERISA plans. These are regulated by federal law, which preempts state insurance mandates, so New York cannot require them to cover IVF at all. Self-funded arrangements are common at very large employers, which means many New Yorkers working for major companies, hospitals, and universities are outside the mandate even though they might assume otherwise. A study of self-insured employers in states with IVF mandates found that only about 41% actually provided full IVF coverage, and many imposed dollar limits lower than the cost of a single cycle.³

Government coverage sits outside the mandate as well. Medicaid managed care, the Essential Plan, and Medicare are not required to cover IVF.²

How to Tell Which Plan Type You Have

The question that decides everything is whether your plan is fully insured or self-funded. Your insurance card usually will not tell you. The most reliable way to find out is to ask your employer’s HR department directly. You can also look at your Summary of Benefits and Coverage, which you can download from your insurer’s portal, and search it for language about infertility treatment, IVF, and fertility preservation.⁴

Once you know the plan type, call the member services number on your card and ask specifically:

Does the plan cover IVF, and how many cycles?
How does the plan define infertility?
Is preauthorization required?
Will I have to try intrauterine insemination first before IVF is approved?
What deductibles, copays, or coinsurance apply?

Network rules matter too. HMO and EPO plans generally limit coverage to in-network providers. PPO and POS plans that cover out-of-network care must also cover out-of-network fertility services.²

What the Three-Cycle Benefit Actually Covers

On a plan subject to the mandate, a “cycle” begins with preparatory medications: ovarian stimulation for a fresh embryo transfer, or endometrial preparation for a frozen embryo transfer. It runs through egg retrieval, embryo creation or freezing, and the subsequent transfer. A cycle that starts but does not complete still counts against your three-cycle lifetime limit.¹

Prescription drugs used in connection with IVF are covered, even if the plan does not otherwise include a prescription drug benefit. Medically necessary storage of eggs or embryos is covered until you hit the three-cycle limit.¹

Insurers cannot impose age restrictions or annual dollar limits on IVF coverage. They can apply deductibles, copayments, and coinsurance, but only at the same level as other benefits under the policy. Preauthorization and medical necessity reviews are permitted, and some plans require patients to attempt intrauterine insemination before approving IVF.² Reversal of voluntary sterilization, GIFT, ZIFT, and experimental procedures are excluded.⁵

Who Qualifies as Infertile Under the Law

To get IVF coverage on a mandated plan, you have to meet the law’s definition of infertility. Infertility is defined as the inability to conceive or to impregnate another person, established by failing to achieve a clinical pregnancy after 12 months of regular unprotected intercourse or therapeutic donor insemination. For women 35 or older, the window shortens to six months. Earlier evaluation and treatment are allowed when medical history or physical findings warrant it.²

Including donor insemination in the definition matters for same-sex female couples and single women. It means they can establish an infertility diagnosis through documented donor insemination attempts without being required to attempt unprotected intercourse. Insurers are prohibited from discriminating based on sexual orientation, gender identity, or marital status, and they cannot force people whose sexual orientation or gender identity is the reason they cannot conceive without assistance to pay out of pocket for donor insemination just to prove infertility.²⁶

Fertility Preservation Is a Separate, Broader Requirement

Fertility preservation is not the same thing as IVF, and the rule that governs it is different. New York’s fertility preservation mandate applies to individual, small group, and large group insurance policies, so it reaches many people the IVF mandate does not.¹

It requires coverage for standard preservation services when a medical treatment may cause iatrogenic infertility, meaning impaired fertility resulting from surgery, radiation, chemotherapy, or other medical treatment. Hormone therapy for gender dysphoria is explicitly included, so people undergoing gender-affirming care qualify.²

Covered services include collection, freezing, preservation, and storage of eggs or sperm, plus related prescription drugs. There are no annual or lifetime dollar limits and no cap on the number of procedures. If you switch insurers, the new insurer must continue covering storage as long as you remain eligible.¹

Two limits are worth knowing. IVF itself is not required as a fertility preservation service. And elective egg freezing to delay family building, absent a medical treatment that threatens fertility, is not covered under this mandate.⁷

Medicaid coverage for fertility preservation is on the way. Governor Kathy Hochul signed the FY 2026 Enacted Budget in May 2025, which includes provisions creating Medicaid coverage for fertility preservation, expected to become available in January 2026.⁸

What IVF Costs Without Coverage

If your plan is not subject to the mandate and your employer does not offer a voluntary fertility benefit, you are paying out of pocket, and the numbers are large. At the NYU Langone Fertility Center, a self-pay IVF cycle using fresh eggs without genetic testing starts at around $17,600. With preimplantation genetic testing, the starting price runs about $20,400 to $21,200. Those figures do not include fertility medications, anesthesia, laboratory testing, or facility charges.⁹⁷

Other procedures at the same center: a frozen embryo transfer starts at around $5,500, intrauterine insemination runs roughly $1,270 to $4,700, and egg freezing starts at about $10,450 to $10,750. Health Savings Accounts and Flexible Spending Accounts are generally eligible for use toward fertility treatment costs.⁷

If Your Insurer Denies Coverage

A denial is not the end of the road. Insurers cannot deny coverage based on age, sexual orientation, gender identity, or marital status, and a denial on any of those grounds is potentially unlawful.²

Start with your plan’s internal appeal. Once that is exhausted, you have the right to an external appeal through the New York Department of Financial Services. You must file within four months of the final internal appeal decision. DFS assigns the case to an independent external appeal agent whose decision binds both you and the insurer. Standard reviews are completed within 30 days. Expedited reviews, available when delay could jeopardize your health or your ability to benefit from treatment, must be completed within 72 hours.¹⁰

Health plans may charge a fee of up to $25 per external appeal, capped at $75 per plan year. The fee is waived for Medicaid enrollees and in cases of financial hardship. You can file online through the DFS portal, by email to earesponse@dfs.ny.gov, or by mail.¹⁰ For general help, DFS can be reached at (800) 342-3736 on weekdays from 8:30 a.m. to 4:30 p.m.¹

Bills That Would Expand Coverage

Several bills in the 2025-2026 legislative session would widen who gets IVF coverage in New York, though none had been signed into law as of mid-2026.

Senate Bill S5545, the Equity in Fertility Treatment Act, sponsored by Senator Brad Hoylman-Sigal, would redefine the three-cycle provision to mean three completed oocyte retrievals with unlimited embryo transfers from those retrievals. It would also require coverage for donor cycles, which are currently excluded, and broaden the definition of infertility to include a person’s inability to reproduce without medical intervention. The bill cleared the Senate Insurance Committee in March 2025 and remained in the Senate Rules Committee as of June 2025.¹¹

Senate Bill S2619, sponsored by Senator Jessica Scarcella-Spanton, would go further, removing the three-cycle limit and extending the IVF mandate to individual insurance policies. As of May 2026, the bill was amended and recommitted to the Senate Insurance Committee.¹²

A separate Scarcella-Spanton bill, S5734, would extend IVF coverage to individual policies and provide three complete oocyte retrievals with unlimited embryo transfers. It was referred to the Senate Women’s Issues Committee in January 2026, where it remained as of mid-2026.¹³

1
NY Department of Financial Services. IVF and Fertility Preservation Law Q&A Guidance
2
NY Department of Financial Services. Infertility Consumer FAQ
3
National Center for Biotechnology Information. Self-Insured Employer Plans and IVF Coverage
4
Illume Fertility. New York State Infertility Mandate
5
CCRM. Dr. Melissa Yih Explains New York’s IVF Preservation Law
6
RESOLVE: The National Infertility Association. New York Insurance Law
7
NYU Langone Fertility Center. Pricing Guide
8
Alliance for Fertility Preservation. Coverage Updates May 2025
9
NYU Langone Health. Fertility Center Financial Information
10
NY Department of Financial Services. File an External Appeal
11
New York State Senate. S5545 – The Equity in Fertility Treatment Act
12
New York State Senate. S2619A
13
New York State Senate. S5734