Is IVF Covered by Insurance in Maryland: Eligibility and Limits

In Maryland, IVF is covered by insurance under a state mandate that requires most fully insured health plans to pay for in vitro fertilization, capped at three attempts per live birth and a $100,000 lifetime benefit. The mandate lives in Section 15-810 of the Maryland Insurance Code, and whether it reaches your plan depends on how your employer buys coverage. Fully insured plans issued in Maryland are in. Small group plans, self-insured employer plans, and plans held by certain religious employers are out.¹

Which Maryland Plans Have to Cover IVF

Section 15-810 applies to insurers, nonprofit health service plans, and HMOs that issue policies in Maryland providing hospital, medical, or surgical benefits. If your employer buys coverage from a carrier and that carrier issues the policy in Maryland, the IVF mandate applies to you.¹

Small group plans are not subject to the mandate. Employees at smaller companies often assume the state rule protects them and find out otherwise only after a denial.

Self-insured employer plans are also outside the mandate, but for a different reason. When an employer funds its own health plan rather than buying insurance from a carrier, the plan falls under the federal Employee Retirement Income Security Act. ERISA preempts state insurance mandates, so Maryland cannot force a self-insured employer to cover IVF. Many mid-size and large employers self-insure. Your plan documents or your benefits department can tell you which category you’re in. Some self-insured employers voluntarily include IVF benefits, and those benefits can differ from what the state mandate provides.

Disputes over a self-insured plan’s IVF coverage are handled federally under ERISA rather than through Maryland’s insurance regulator.

Who Qualifies for Coverage

Being on a covered plan is only the first step. The statute layers on eligibility conditions, and all of them have to be met:

A documented history of infertility, meaning the inability to conceive after unprotected intercourse over a reasonable period, or the inability to sustain a successful pregnancy.
You must be the policyholder or the policyholder’s spouse.
You must have tried other, less expensive infertility treatments covered by your plan before moving to IVF, and your insurer will expect documentation showing those efforts failed.
The IVF procedures must be performed at a facility that conforms to guidelines or minimum standards set by the American College of Obstetricians and Gynecologists or the American Society for Reproductive Medicine.

The facility requirement is not a formality. A clinic that does not meet ACOG or ASRM standards gives your insurer grounds to deny the claim outright. Before starting treatment, confirm the clinic’s compliance with your insurer in writing.¹

What the Coverage Actually Pays For

Insurers may limit IVF coverage to three attempts per live birth, with a maximum lifetime benefit of $100,000. Both limits work together. If your first three attempts don’t produce a live birth, coverage for further cycles is exhausted. If you do have a live birth, the three-attempt count resets for future treatment, but the $100,000 lifetime cap continues to apply across all cycles.¹

A single IVF cycle with medications commonly runs between $12,000 and $30,000, so three cycles can approach or exceed the $100,000 ceiling depending on treatment complexity. Once you hit the cap, everything after that is out of pocket. Keep your own running tally of what your insurer has paid so you aren’t surprised mid-treatment.

Frozen embryo transfers are considered part of IVF treatment, but how insurers count a frozen transfer toward the three-attempt limit varies. Ask your plan administrator for the specific policy before starting a cycle that involves cryopreserved embryos.

When the Mandate Doesn’t Apply

Religious Employer Exclusion

If the IVF coverage requirement conflicts with the bona fide religious beliefs and practices of a religious organization, that organization can request that IVF be excluded from its policy. The insurer must then remove IVF coverage from the contract with that employer. This is a statutory right, not a case-by-case determination. If your employer is a religious organization that has opted out, your plan will not include IVF benefits.¹

Non-Infertility Uses

The mandate treats infertility as a medical condition. It does not extend to IVF performed for reasons unrelated to infertility, such as elective gender selection or use by individuals who have not been diagnosed as infertile. Every eligibility requirement traces back to documented medical inability to conceive or carry a pregnancy.

Same-Sex Couples

Maryland’s statute has a specific provision addressing same-sex married couples, but it governs infertility benefits other than IVF. For those non-IVF treatments, insurers cannot require that a same-sex spouse’s sperm be used or that infertility be shown exclusively through a history of heterosexual intercourse.¹

The IVF-specific requirements still reference traditional infertility criteria, which can create hurdles for same-sex couples seeking IVF. A denial on those grounds may be worth challenging through the appeals process, and an attorney familiar with Maryland insurance law can help evaluate the options.

What to Do If Your IVF Claim Is Denied

Maryland gives you a structured, three-stage path to challenge a denial.

Start with your health plan’s internal grievance process. Your denial letter must explain how to file a grievance and must also tell you how to contact both the Maryland Insurance Administration and the Maryland Attorney General’s Health Education and Advocacy Unit. File the grievance with supporting documentation from your treating provider.²

If the internal grievance doesn’t resolve the denial, you can bring a complaint to the Maryland Insurance Administration within four months of the plan’s grievance decision. The MIA uses medical experts to review these cases, and the Insurance Commissioner has authority to overturn a denial if the treatment is medically necessary. The Attorney General’s Health Education and Advocacy Unit will assist you free of charge at this stage.²

If you’re still unsatisfied after the MIA’s decision, you can request a hearing in writing. The MIA may also contract with an Independent Review Organization to evaluate medical necessity disputes.³

Paying for What Insurance Doesn’t

Whether your plan covers IVF fully, partially, or not at all, the out-of-pocket share is usually significant. A few tools help.

HSAs and FSAs

IVF is generally a qualified medical expense under IRS guidelines because it treats a recognized medical condition, so HSA and FSA funds can pay for IVF procedures and prescribed fertility medications.⁴⁵ Short-term embryo storage tied to an active treatment cycle may qualify for reimbursement, but long-term or indefinite storage typically does not. Budget for those storage fees separately.

Federal Medical Expense Deduction

IVF costs you pay yourself, including procedures and temporary egg or sperm storage, qualify as deductible medical expenses on Schedule A. The IRS specifically lists in vitro fertilization among includible fertility-related costs. You can only deduct the portion of total medical expenses that exceeds 7.5% of your adjusted gross income, and you have to itemize.⁶

Surrogacy costs are excluded. The IRS does not allow deductions for the identification, compensation, or medical care of a gestational surrogate, because those payments go toward someone who is not you, your spouse, or your dependent.⁶

Timing matters. Medical expenses are deductible in the year you pay them, not the year you receive treatment. IVF costs charged to a credit card in December count for that tax year even if you don’t pay off the card until the following year.⁷

COBRA Mid-Treatment

If you lose your job while going through IVF, COBRA continuation coverage must be identical to what similarly situated active employees receive, including any IVF benefits your plan provides. You pay the full premium plus a 2% administrative fee, and any change the employer makes to the plan for active employees also applies to you. The standard COBRA election window is 60 days from the date you’re notified of eligibility, and coverage generally lasts up to 18 months after a job loss.⁸ If you’re mid-cycle and thinking about a job change, price out COBRA before you give notice.

1
Maryland General Assembly. Maryland Insurance Code 15-810 – Benefits for In Vitro Fertilization
2
Maryland Insurance Administration. Appeals and Grievance
3
Maryland Insurance Administration. Health Care Appeals and Grievance Law 2024 Report
4
Internal Revenue Service. Expanded Availability of Health Savings Accounts Under the OBBBA
5
FSAFEDS. New 2026 Maximum Limit Updates
6
Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses
7
Internal Revenue Service. Topic No. 502, Medical and Dental Expenses
8
DOL.gov. FAQs on COBRA Continuation Health Coverage for Workers