IVF and Open Enrollment 2027: How to Pick a Plan That Pays for It

Open enrollment is the one time a year you can choose who pays for IVF. Choose well and a cycle can cost you a plan's out-of-pocket limit. Miss it and you may be paying $23,000 to $30,000 per cycle yourself, with no way to change plans for a year.

This guide is for anyone who may need IVF in 2027 and is about to pick a health plan: on HealthCare.gov, through a job, through a partner's job, or as a federal employee. It covers the deadlines, how to tell whether any law requires your plan to cover IVF, the questions that reveal what a plan really pays, and the arithmetic for comparing plans. It is general information, not insurance or tax advice, and the plan's own documents always decide.

The 2027 deadlines

The HealthCare.gov dates are from its dates and deadlines page, and the federal dates from the Office of Personnel Management. After a window closes you can generally change plans only after a qualifying life event, and needing IVF is not one, so this decision usually holds for the whole plan year.

First, work out which rules reach your plan

Whether IVF is covered depends less on the insurer's name than on what kind of plan you are in. Three kinds behave very differently.

Marketplace plans you buy yourself. A marketplace plan must cover what its state's benchmark plan and insurance laws require. When we read every state's rule on October 21, IVF was required in only 9 states and DC: Arkansas (not on HMO plans), Connecticut, Delaware, Hawaii (one cycle), Illinois, Maine, Maryland, Massachusetts, Rhode Island and the District of Columbia, each with its own limits. In 15 more states plans must cover some infertility care, such as tests or insemination, but not IVF. In the other 26, the benchmark plan lists infertility treatment as not covered. A plan can still offer more than its state requires, so check each plan you are considering.

Job-based plans the insurer pays for ("fully insured"). State insurance laws reach these. If your state has an IVF law and your employer's plan is fully insured, the law generally applies, within its own limits. Some laws depend on company size: in California, SB 729 requires large-group fully insured plans (more than 100 employees) to cover up to three completed egg retrievals with unlimited embryo transfers, while small-group plans only have to offer it. Some laws also change for 2027: Connecticut's Public Act 26-33 widens its definition of infertility from January 1, 2027, without changing its cycle limits. Our insurance page sets out what each state's law says.

Job-based plans the employer pays for ("self-funded"). No state law reaches these. The employer writes its own fertility benefit, or none, whatever your state requires. This is the most common kind: according to KFF's 2025 employer survey, 67% of covered workers are in self-funded plans, and 80% at larger firms.

This surprises a lot of people, because the same insurer's name can be on both kinds. An insurer's card does not tell you who pays the claims.

How to tell which you have. Ask HR one question: "Is our medical plan fully insured or self-funded?" The plan's Summary Plan Description usually says too, often in a line saying the insurer only provides administrative services. If you are self-funded, skip the state law entirely and read your employer's benefit.

What to ask before you enroll

Do not stop at "does it cover IVF?". A yes can mean one cycle, or diagnosis only, or a benefit you lose if you enroll in it the wrong way. These are the questions that separate plans, each with a real example of why it matters. The examples are from employers' own documents as we read them, and 2027 documents may differ.

1. Is IVF itself covered, or only tests and treating the cause? Many plans cover a diagnosis and stop there. On a marketplace plan, open the Summary of Benefits and Coverage and look for infertility treatment both among the services the plan does not cover and among its other covered services.
2. What is the limit, and in what unit? Limits are written in cycles, retrievals, or dollars, and those are not equivalent. Adobe's Aetna plans list three cycles per lifetime. American Airlines' BCBS Plus Plan lists a $50,000 lifetime maximum. Amazon's benefit runs through Maven as one lifetime Maven cycle per member, with 12 credits to spend on care.
3. Are fertility drugs covered separately? Medication is one of the largest lines of a cycle. American Express lists $25,000 for medical care and $20,000 for drugs. Adobe lists a separate $60,000 lifetime maximum for drugs.
4. Is there anything you must do first? American Express says you must enroll in its Healthy Babies program, through Maven, before treatment for the coverage to apply. Others require prior authorization or an in-network clinic.
5. Is your clinic in network? A generous benefit may only pay at a set list of clinics. Ask for the list, and check any clinic you are considering against it.
6. Who qualifies? Ask how the plan defines infertility, how long you must have tried, whether it requires you to have been covered for a period first, and how it treats single people, same-sex couples, and donor eggs or sperm. Connecticut's law, for instance, covers people who have been on the plan for at least 12 months.
7. What else is included? Embryo freezing, frozen transfers, genetic testing of embryos and storage are often treated separately, and each can be a real cost. See what clinics charge for frozen transfers, genetic testing and storage.
8. Does your share count toward the out-of-pocket limit? This is the question most people miss, and the next section explains why.

Call the plan, ask these, and get the answers in writing if you can. A phone representative's summary is not the plan document.

The out-of-pocket limit is not always what caps your bill

For 2027, the federal cap on in-network cost sharing is $12,000 for one person and $24,000 for a family. Many plans set lower limits. So it is tempting to reason that a covered cycle can never cost more than your plan's limit.

That holds only if IVF counts as an essential health benefit under your plan. The federal agencies' 2026 proposed rule on fertility benefits spells out that benefits which are not essential health benefits are not subject to the maximum out-of-pocket requirement or to the ban on annual and lifetime dollar limits. That is why fertility benefits can carry lifetime dollar caps at all, and why IVF costs may or may not count toward your limit. Ask: "Does what I pay for IVF and fertility drugs count toward my out-of-pocket maximum?"

The sums that decide it

Compare what the year would cost, not what the premium costs. For each plan you can choose:

Your year = premiums + what you pay for IVF under that plan, up to its limit if IVF counts + anything above the plan's IVF maximum.

Then compare with paying yourself: $23,000 to $30,000 per cycle, and $40,000 to $60,000 across the cycles many people need. Our cost calculator will work it through for your age and state, and what clinics actually post shows where your local prices sit.

Here is how that plays out, with round numbers chosen only to show the method. Suppose Plan A covers IVF with a $9,000 out-of-pocket limit that IVF counts toward, and costs $150 a month more than Plan B, which does not cover it.

• Plan A adds $1,800 in premiums and up to $9,000 in cost sharing: at most $10,800 for the year, however many cycles the benefit pays for.
• Plan B costs you the whole price of every cycle.

With numbers like these, the costlier plan wins as soon as you are confident of treatment that year. If you are unsure you will start in 2027 the sum is closer, so price the year with no treatment too.

Timing matters as much as the plan. Deductibles and out-of-pocket limits reset at the start of each plan year. A retrieval in December and a transfer in January can mean paying both years' limits, while the same treatment within one plan year pays one. If your limit is already nearly met in 2026, it can be worth asking your clinic what can be done before it resets. If you are about to start, ask whether starting in January under a better plan would cost you less. When to treat is a medical question first, especially as age affects the odds, so raise it with your clinic rather than deciding on cost alone.

If you have two plans to choose from

If you and a partner each have job-based coverage, open enrollment is when you can compare both. A good fertility benefit on one partner's plan can outweigh a cheaper premium on the other's. Ask three things:

• Whose coverage does the benefit follow? Some benefits cover a spouse or partner enrolled in the plan, and some count per person. Amazon's enrollment page lists a separate cycle for a spouse or partner on an Amazon health plan.
• Do you need proof for a domestic partner? Many employers require it, and the deadline is often the same as the enrollment deadline.
• Which plan pays for male-factor care? If the need is on one partner's side, check how the plan treats treatment for a member whose partner is not on the plan.

We keep what 100 large employers say about IVF, each from its own documents: 59 of them state they cover IVF. If you are weighing a job change, read that page too, because some benefits have a waiting period or require a set number of hours a week.

Federal employees

Every FEHB carrier must cover IVF drugs for three cycles and every plan must cover freezing eggs or sperm before treatment that causes infertility, but IVF itself is covered only on plans that include it. In their 2026 brochures, FEP Blue Standard and GEHA High pay up to $25,000 a year. The 2027 brochures were not posted when we read them on October 12, so read the 2027 one for any plan you consider. Plan by plan, it is all on our FEHB page.

Pre-tax money: decide this at open enrollment too

IVF is a medical expense for tax purposes. IRS Publication 502 names "in vitro fertilization (including temporary storage of eggs or sperm)". It sends surrogacy costs elsewhere, under what is not included, so do not assume those qualify.

Flexible Spending Account (job-based plans only). You choose the amount during open enrollment, and generally cannot change it mid-year.

• The limit for 2026 is $3,400, with up to $680 carried over if your plan allows it. The IRS had not published the 2027 figure when we checked on October 31.
• A spouse can put in the same amount at their own employer, which doubles it for a couple with two jobs.
• You generally must use the money within the plan year, so only elect what you expect to spend.
• Ask whether your whole election can be claimed from the start of the plan year. That is how health FSAs usually work, and it matters if your treatment falls early in the year.
• You cannot use an FSA with a marketplace plan.

Health Savings Account (high-deductible plans). For 2027, the IRS allows $4,500 for one person and $9,000 for family coverage. The plan must have a deductible of at least $1,750 or $3,500, and out-of-pocket costs of no more than $8,700 or $17,400. The money stays yours from year to year, so an HSA works if you are saving ahead. Check that the plan's IVF benefit, if any, is worth having before you pick a high-deductible plan for the account.

What may change for 2027

The federal agencies proposed a new kind of standalone fertility benefit in May 2026: a separate benefit an employer could offer outside its main medical plan, with a lifetime maximum of $120,000 per participant, indexed to medical inflation. It would not make any employer offer one. We found no final rule when we checked on October 31. It is still worth asking HR: "Are you offering any separate fertility benefit for 2027?" Our guide to the companies that run these benefits explains how they work.

If no plan you can get covers IVF

That is the usual case in the 26 states where the benchmark leaves it out, and it does not mean you are out of options. Compare IVF grants that are open now, refund programs that clinics post, what IVF loans really cost, and clinics' posted prices. If you are in a state where every plan excludes it, a job-based plan you or a partner can join may be the only route to coverage, so it is worth knowing about for next year.

Your checklist

1. Find your deadline, and put it in your calendar a week early.
2. Ask HR whether your plan is fully insured or self-funded.
3. If fully insured or on a marketplace plan, read your state's rule. If self-funded, read your employer's benefit.
4. Ask the eight questions above about every plan you could choose, including a partner's.
5. Run the sum: premiums, your share of IVF, and whatever falls above the plan's maximum.
6. Decide your FSA or HSA amount before the window closes.
7. Keep the written answers, and read your 2027 plan document when it arrives.

Common questions

Can I change plans after open enrollment if I find out I need IVF? Generally not. Needing treatment is not a qualifying life event. Marriage, a new job, a move or losing other coverage can be, so a change like that can open a window.

Does Obamacare cover IVF? Only where the state's benchmark plan or insurance law requires it, or where a plan chooses to offer it. When we read the rules on October 21, that requirement existed in 9 states and DC. See our state-by-state answer.

Does my state's IVF law apply to my job's plan? Only if the plan is fully insured. A self-funded plan sets its own benefit whatever your state requires, and most covered workers are in one.

Can I use my FSA for IVF? Yes: IRS Publication 502 lists it as a medical expense. You cannot have an FSA with a marketplace plan, though a high-deductible marketplace plan can pair with an HSA.

Which insurer is best for IVF? The question that counts is which plan. The same insurer can run plans with no benefit and plans with a generous one, so compare the plans you can actually join. Our insurer pages set out what each insurer's own policy says, and your plan's document decides.