The Affordable Care Act (ACA) does not mandate coverage for infertility services. However, some states require that specific plans include coverage for certain infertility treatments, such as the diagnosis and treatment of infertility, but not the in vitro process. When shopping for health coverage, if you require these services, it's important to review plan details regarding coverage and out-of-pocket costs for infertility care. The ACA requires individual and small-group health plans to cover 10 essential health benefits (EHB), but assisted reproductive technology is not categorized as an EHB unless a state explicitly chooses to include it.
How do I check what is covered by a plan while shopping?
To begin looking at plans available in your area, begin the quoting process by entering your residential zip code here: https://www.healthsherpa.com/shopping?_agent_id=nil&carrier_id=nil&source=agent-home
After entering in your household information (who needs coverage, projected household income, etc.) you will be brought to a list of plans available in your area
To see the coverage associated with a specific plan, click on the Plan details button on the plan card
Next, select the Summary of benefits and coverages (PDF) link. This will bring you to a PDF created by the insurance company that clearly outlines the coverage that specific plan offers and coverage levels available to the consumer.
Please note, you can use the CONTROL+F search function to use key words to search the PDF
Need Help?
If you would like assistance with your plan selection process please call our Consumer Advocate team at 855-772-2663, Monday–Friday, 6am–4pm PT.