Is IVF Covered by Insurance in Colorado? Mandate and Costs

IVF is covered by insurance in Colorado only on certain plans. Under the Colorado Building Families Act, large-group fully insured health plans regulated by the state have been required to cover in vitro fertilization and other fertility services since January 1, 2023.¹ If you’re on an individual plan, a small-group plan, or a self-funded employer plan, the mandate does not reach you, and whether you have IVF benefits depends entirely on what your carrier or employer chose to include.

Which Colorado Plans Have to Cover IVF

The single question that decides your coverage is what kind of plan you have. The Colorado mandate applies to one category, and leaves several of the largest categories out.

Large-Group Fully Insured Plans

If your employer has more than 100 employees and buys a health insurance policy from a carrier (rather than paying claims directly), your plan is almost certainly subject to the Building Families Act. These plans have been required to cover fertility diagnosis, treatment, and preservation since the start of 2023.¹ One wrinkle: if your employer’s insurance is regulated by another state (which can happen when the company is headquartered elsewhere), Colorado’s rules generally don’t control.

Self-Funded Employer Plans

Many large employers, especially those with 500 or more workers, don’t buy insurance at all. They pay claims directly out of company funds and hire a carrier only to administer the plan. These self-funded plans are governed by the federal ERISA statute, which preempts state insurance mandates.² Colorado cannot force a self-funded plan to cover IVF. Some self-funded employers add fertility benefits voluntarily to stay competitive in hiring, but there is no legal right to that coverage.

If you’re not sure which type you have, your HR or benefits office can tell you. It’s the first thing to find out.

Individual and Small-Group Plans

This is where the law is more promise than reality. The statute does extend the mandate to individual and small-group plans, but only twelve months after the federal Department of Health and Human Services determines that the coverage doesn’t count as an additional Essential Health Benefit that Colorado would have to pay for under the ACA.¹ That federal determination has not happened. A 2024 bill (HB24-1025) that would have imposed the mandate without waiting did not pass.³

So if you buy coverage through Connect for Health Colorado, you’re self-employed, or you work for a business with fewer than 100 employees, you have no guaranteed IVF benefit today. As of late 2024, roughly 36% of individual-market enrollees and 25% of small-group enrollees in Colorado had IVF coverage through plans that offered it voluntarily.³ Check your plan documents regardless; some carriers include it even where the law doesn’t require them to.

What the Mandate Actually Covers

When your plan is subject to the Building Families Act, the required benefits are specific. The law requires coverage of:

Up to three completed oocyte (egg) retrievals.
Unlimited embryo transfers following those retrievals, consistent with American Society for Reproductive Medicine guidelines, including single embryo transfer when medically appropriate.
Standard fertility preservation services for people facing medically induced infertility, such as those about to undergo cancer treatment.
Diagnostic testing, procedures, and medications recommended by a licensed physician under ACOG or ASRM guidelines.

Plans also can’t single out fertility care for worse treatment. Deductibles, copays, coinsurance, and benefit caps on fertility services must match what the plan applies to other medical care, and the same parity rule applies to fertility medications.¹

Who Qualifies

Under the statute, infertility means the inability to conceive after a period of unprotected intercourse or therapeutic donor insemination: 12 months for women under 35, or six months for women 35 and older.¹

Colorado’s definition is unusually inclusive. It extends to single unpartnered individuals and LGBTQ+ individuals, so you do not need to be in a heterosexual relationship or document failed attempts at conception through intercourse to qualify.⁴

Religious Employer Exception

A religious employer can request an exclusion if the coverage conflicts with the organization’s religious beliefs and practices. An employer that obtains the exclusion must give employees reasonable and timely notice that fertility coverage is not part of the plan.¹

How to Confirm Your Own Coverage

Knowing the law isn’t the same as knowing your benefit. Four steps will get you a reliable answer:

Ask HR whether your plan is fully insured or self-funded, and whether it’s classified as large group (more than 100 employees). That one answer tells you if the Colorado mandate applies.
Pull your Summary of Benefits and Coverage and Evidence of Coverage. Search for “infertility,” “IVF,” and “fertility preservation.”
Call the member services number on your insurance card. Ask about IVF coverage, pre-authorization requirements, in-network fertility clinics, and cost-sharing for retrievals, transfers, and medications.
Get the answer in writing. Phone reps sometimes misstate fertility benefits, and a written summary is what you’ll need if you later have to appeal a denial.

If Your Claim Is Denied

Denials happen even on plans that should cover treatment, often because of coding errors, missed pre-authorizations, or a carrier’s interpretation of medical necessity. You have two levels of appeal.

File an internal appeal with the insurer first. Your denial letter or Explanation of Benefits spells out how and by when. If that fails, request an external review by an independent reviewer. You have four months from the final internal denial to file.⁵ The external reviewer’s decision binds your carrier: a ruling in your favor means they must cover the treatment.

Standard external reviews are decided within 45 days. If a treatment window is closing because of your age or an upcoming medical procedure, you can request an expedited review that must be resolved within 72 hours.⁵ You can also appoint a representative, including your fertility doctor, to file for you. Fees are capped at $25, and there’s no charge if your insurer uses the federal external review process.

Paying for IVF Without Full Coverage

If you fall into one of the gaps, or your covered plan still leaves significant cost-sharing, a single IVF cycle including medications typically runs $15,000 to $25,000. Several tools can soften that.

HSA and FSA Dollars

If you have a high-deductible health plan, a Health Savings Account lets you pay for IVF and fertility medications with pre-tax dollars. For 2026, the HSA contribution limit is $4,400 for self-only coverage and $8,750 for family coverage.⁶ HSA balances roll over year to year, which lets you save ahead of treatment. A health care Flexible Spending Account also covers IVF, with a 2026 limit of $3,400, but unspent FSA funds generally don’t carry over.

Both accounts cover procedures, medications, and temporary storage of eggs or sperm. Longer-term storage past a year may not qualify, and elective egg freezing that isn’t medically necessary may require a Letter of Medical Necessity from your provider.

Medical Expense Deduction

Out-of-pocket IVF costs, including procedures, fertility medications, and temporary egg or sperm storage, qualify as deductible medical expenses on your federal return.⁷ If you itemize on Schedule A, you can deduct the portion of your total medical expenses that exceeds 7.5% of your adjusted gross income. Given how expensive IVF is, many people clear that threshold in a treatment year even if they don’t normally itemize. Surrogacy expenses are not deductible.

Fertility Grants

Several national nonprofits offer grants for fertility treatment. Deadlines and eligibility vary, and competition is real, but the money is worth pursuing if you’re paying out of pocket:

Tinina Q. Cade Foundation awards up to $10,000 for IVF, IUI, donor egg, or gestational carrier costs. Applicants need a doctor’s infertility diagnosis and U.S. citizenship or permanent residency.
Gift of Parenthood awards quarterly grants of $5,000 to $20,000 for IVF, IUI, and egg donation.
Hope for Fertility Foundation awards $500 to $10,000 on a biannual application cycle.
Worth the Wait awards $500 to $2,500 year-round, specifically for young adult cancer survivors seeking fertility treatment.

Most of these programs charge a modest application fee ($50 to $75) and require documentation of your infertility diagnosis. Application windows open and close through the year, so confirm each organization’s current deadlines before you plan around them.

1
Justia Law. Colorado Code 10-16-104 – Rules
2
The Commonwealth Fund. State Cost-Control Reforms and ERISA Preemption
3
DORA – Division of Insurance. Fertility Treatment Coverage Analysis
4
Colorado General Assembly. HB20-1158 Insurance Cover Infertility Diagnosis Treatment Preserve
5
HealthCare.gov. External Review
6
IRS. Rev. Proc. 2025-19
7
IRS. Publication 502 (2025), Medical and Dental Expenses