To require health insurance plans to provide coverage for fertility treatment, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Access to Fertility Treatment and Care Act mandates that virtually all health insurance plans in the United States -- private group and individual plans, Federal Employees Health Benefits, TRICARE (military), Medicaid, and Medicare -- cover fertility treatment if they cover obstetrical services. Fertility treatment is broadly defined to include egg/sperm/embryo preservation, artificial insemination, IVF and assisted reproductive technology, genetic testing of embryos, fertility medications, and gamete donation. Coverage must be provided regardless of whether the patient has been diagnosed with infertility, as long as the provider deems it appropriate and the facility meets federal standards. Cost-sharing for fertility treatment cannot exceed what is charged for other medical services. For Medicare specifically, fertility treatment is covered at 100% with no deductible. The bill also prohibits insurers from incentivizing patients to forgo fertility treatment, gagging providers, penalizing providers who offer fertility services, or discriminating based on civil rights grounds. Plans must provide written annual notice to enrollees about their fertility coverage rights.
Who Benefits and How
Individuals and couples seeking fertility treatment benefit from dramatically expanded insurance coverage across all major health plan types, removing out-of-pocket costs that currently average $15,000-$30,000+ per IVF cycle. Fertility clinics, reproductive endocrinologists, and IVF providers benefit from a massive expansion of insured patient volume and guaranteed reimbursement. Pharmaceutical companies manufacturing fertility drugs (gonadotropins, progesterone, etc.) benefit from expanded covered prescriptions. Genetic testing companies benefit from mandated coverage of embryo genetic testing. Veterans and their spouses/partners gain access to fertility treatment through the VA. Medicare beneficiaries gain fertility coverage at 100% with no cost-sharing. Medicaid recipients gain fertility treatment coverage through state plans. Federal employees and military service members gain coverage parity.
Who Bears the Burden and How
Health insurance companies and self-insured employers bear significantly higher claims costs from mandatory fertility treatment coverage, which will likely be passed through as higher premiums. Federal taxpayers bear the cost of Medicare coverage at 100%, FEHBP coverage, TRICARE coverage, and enhanced Medicaid matching funds. State governments bear additional Medicaid costs for fertility treatment coverage under their state plans. The Department of Health and Human Services bears regulatory costs for promulgating interim final regulations. The Department of Defense bears implementation and regulatory costs for TRICARE. The Department of Veterans Affairs bears costs for providing fertility services to veterans and their families.
Key Provisions
- Mandates fertility treatment coverage in all private group and individual health plans that cover obstetrical services
- Amends three federal statutes simultaneously: Public Health Service Act, ERISA, and Internal Revenue Code
- Fertility treatment defined broadly: preservation, insemination, IVF/ART, genetic testing, medications, gamete donation
- No infertility diagnosis required -- coverage based on provider determination of appropriateness
- Cost-sharing may not exceed that applied to other medical services
- Medicare covers fertility treatment at 100% with no deductible
- Medicaid plans must include fertility treatment as family planning services with enhanced federal match
- FEHBP and TRICARE must provide equivalent coverage
- Veterans and spouses/partners may apply for fertility treatment through VA
- Plans may not incentivize patients to forgo treatment, gag providers, or penalize providers
- Anti-discrimination protections under civil rights laws explicitly apply
- Annual written notice to enrollees required
- Effective 6 months after enactment for private plans; collective bargaining exception applies
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Mandates comprehensive fertility treatment coverage across virtually all U.S. health insurance systems -- private plans (PHSA/ERISA/IRC), Federal Employees Health Benefits, TRICARE, Medicaid, Medicare, and VA -- by defining fertility treatment broadly and prohibiting cost-sharing that exceeds other medical services.
Key Policy Areas
Healthcare, Insurance, Defense, Veterans Affairs
Primary Purpose
Mandates comprehensive fertility treatment coverage across virtually all U.S. health insurance systems -- private plans (PHSA/ERISA/IRC), Federal Employees Health Benefits, TRICARE, Medicaid, Medicare, and VA -- by defining fertility treatment broadly and prohibiting cost-sharing that exceeds other medical services.
Policy Domains
Veterans Fertility Treatment (Sec. 5)
Identified Gains
Contextual inference, no direct clause citation- Veterans seeking fertility treatment
- Spouses and partners of veterans
- Fertility treatment providers in VA network
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Department of Veterans Affairs (implementation and service costs)
- Federal taxpayers
Contextual inference, no direct clause citation
Federal Employees Health Benefits (Sec. 3)
Identified Gains
Contextual inference, no direct clause citation- Federal employees and their dependents
- Fertility treatment providers
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Federal taxpayers (FEHBP premium contributions)
- FEHBP participating insurers
Contextual inference, no direct clause citation
State Medicaid Coverage Mandate (Sec. 6)
Identified Gains
Contextual inference, no direct clause citation- Low-income individuals seeking fertility treatment
- Fertility treatment providers in Medicaid-participating networks
- States (via enhanced federal matching rate)
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Federal taxpayers (90% match rate)
- State governments (10% state share plus administrative costs)
- CMS (regulatory oversight)
Contextual inference, no direct clause citation
TRICARE Military Coverage (Sec. 4)
Identified Gains
Contextual inference, no direct clause citation- Active duty service members and dependents
- Military retirees
- Fertility treatment providers near military installations
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Department of Defense budget
- Federal taxpayers
Contextual inference, no direct clause citation
Medicare Coverage at 100% (Sec. 7)
Identified Gains
Contextual inference, no direct clause citation- Medicare beneficiaries seeking fertility treatment
- Fertility treatment providers accepting Medicare
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Federal taxpayers (Medicare trust fund)
- CMS (claims processing and implementation)
Contextual inference, no direct clause citation
Private Insurance Coverage Mandate (Sec. 2)
Identified Gains
Contextual inference, no direct clause citation- Individuals and couples seeking fertility treatment
- Fertility clinics and reproductive endocrinologists
- IVF and ART providers
- Fertility pharmaceutical manufacturers
- Genetic testing companies
- Gamete donors and donation agencies
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Health insurance companies
- Self-insured employers
- Enrollees (via premium increases)
- HHS (regulatory implementation)
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMs. DeLauro (for herself, Mr. Doggett, Ms. Schakowsky, and Mrs. …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Fertility clinics and IVF providers, Fertility treatment providers, Fertility treatment providers accepting Medicare
Employees in ERISA plans, Federal taxpayers (90% match rate), Federal taxpayers (FEHBP employer contribution)
Positive-direction: Employees in ERISA plans, Individuals in PHSA-regulated plans, Individuals seeking fertility treatment, Low-income individuals seeking fertility treatment, Medicare beneficiaries seeking fertility treatment, Participants in IRC-regulated plans
Negative-direction: Federal taxpayers (90% match rate), Federal taxpayers (FEHBP employer contribution), Federal taxpayers (Medicare trust fund), Health plan enrollees (premiums)
ERISA-regulated group health plans, Employer plan sponsors, FEHBP participating insurers
CMS (implementation and claims processing), Department of Defense, Department of Defense (budget)
Positive-direction: Federal employees and dependents, States (net fiscal benefit from 90% match)
Negative-direction: CMS (implementation and claims processing), Department of Defense, Department of Defense (budget), State Medicaid programs, State governments (budgets)
Active duty service members and dependents, Military retirees and dependents, TRICARE beneficiaries
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Defense
- "the_secretary"
- → Secretary of Veterans Affairs
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Note: {'term': 'The Secretary', 'resolution': 'Refers to the Secretary of HHS in Sections 2, 6, and 7; the Secretary of Defense in Section 4; the Secretary of Veterans Affairs in Section 5. Section 3 (FEHBP) references the PHSA definition without naming a specific Secretary.'}
Key Definitions
Terms defined in this bill
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology