Does Oscar cover IVF?
What Oscar's individual plan contracts and its clinical guideline say about covering IVF and other fertility treatment, in their own words, with the document each statement is in.
- Documents read · checked 16 h ago
Not on the Oscar individual plans we read. Oscar's evidences of coverage for Texas (2026), Florida (2026) and Georgia (2027) all say the plan does not cover artificial insemination, IVF, donor eggs or sperm, or drugs and services to treat infertility. They do cover tests to find the cause of infertility, and the Texas and Georgia plans cover fertility preservation before treatment that may cause infertility. Oscar's clinical guideline (revised August 1, 2026) says IVF depends on the member's benefit plan, so a plan in another state can differ.
What Oscar's own documents say
Read on Oct 12, 2026. The words in quotation marks are the source's own.
Not on the individual plans we read
“We do not cover: ● Artificial insemination ● IVF, GIFT, ZIFT ● Services for procurement and storage of donor semen/eggs ● Drugs/Services to treat infertility”
“Assisted reproductive technologies such as in vitro fertilization (IVF), gamete intrafallopian tube transfers (GIFT), zygote intrafallopian tube transfers (ZIFT), or donor services (oocyte, ovum, sperm) are also subject to the member’s benefit plan for coverage eligibility.”
What these plans do cover
Diagnostic and exploratory procedures to find the cause of infertility, including surgery to correct a diagnosed condition.
“We cover diagnostic and exploratory procedures to determine infertility, including surgical procedures to correct diagnosed diseases or conditions.”
Infertility drugs
The plans do not cover oral or injectable drugs to diagnose or treat infertility.
“Your Oscar plan does not cover oral and injectable medications for the diagnosis or treatment of infertility.”
How Oscar defines infertility
Oscar's guideline counts infertility after 12 months or cycles before age 35, or 6 at 35 and over, of unprotected intercourse or donor insemination, and says lacking a sex partner does not by itself meet the definition. It considers infertility services not medically necessary for members 40 or older with natural menopause.
““Infertility” refers to the failure to establish a successful pregnancy after 12 months/cycles for women (biological females) before 35 years of age, or after 6 months/cycles for women greater or equal to 35 years of age with unprotected heterosexual intercourse or therapeutic donor insemination.”
“Infertility is not defined to include the inability to conceive due to lack of a sex partner”
“Infertility service requests for members 40 years or older who have a diagnosis of natural menopause (permanent cessation of menses for at least 12 months) are considered NOT medically necessary.”
Texas: a plan without some state-required benefits
Oscar's Texas HMO is a Consumer Choice plan, which means it does not provide every benefit Texas normally requires in a health plan.
“This Consumer Choice of Benefits Health Maintenance Organization health care plan, either in whole or in part, does not provide state-mandated health benefits normally required in evidences of coverage in Texas.”
Oscar individual plans, by state
The three evidences of coverage we read, in Oscar's own words.
Texas (2026)
IVF excludedDoes not cover insemination, IVF, donor eggs or sperm, or infertility drugs and services. Covers fertility preservation before medically necessary cancer treatment that may impair fertility.
“We do not cover: ● Artificial insemination ● IVF, GIFT, ZIFT ● Services for procurement and storage of donor semen/eggs ● Drugs/Services to treat infertility”
“We cover fertility preservation services to a covered person who will receive a medically necessary treatment for cancer, including surgery, chemotherapy, or radiation”
Florida (2026)
IVF excludedDoes not cover insemination, IVF, donor eggs or sperm, or infertility drugs and services, and excludes freezing eggs or sperm.
“We do not cover: ● Artificial insemination ● IVF, GIFT, ZIFT ● Services for procurement and storage of donor semen/eggs ● Drugs/Services to treat infertility”
“Cryopreservation of sperm or eggs, or storage of sperm for artificial insemination. This includes donor fees.”
Georgia (2027)
IVF excludedThe 2027 contract keeps the exclusion of insemination, IVF, donor eggs or sperm, and infertility drugs and services. It covers standard fertility preservation when a medically necessary treatment may cause infertility, including storage of eggs or sperm for up to one year.
“We do not cover: ● Artificial insemination ● IVF, GIFT, ZIFT ● services for procurement and storage of donor semen/eggs ● Drugs/Services to treat infertility”
“Fertility Preservation Medically Necessary services and supplies for standard fertility preservation treatments are covered when a Medically Necessary treatment may directly or indirectly cause iatrogenic infertility.”
“Such coverage shall include: ● Evaluation expenses; ● Laboratory assessments; ● Medications; and ● Treatments associated with standard fertility preservation services, including storage of gametes for up to one year.”
How to see what your Oscar plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1Read your own plan's Evidence of Coverage and Schedule of Benefits: Oscar's guideline says coverage follows the member's policy and state and federal law.
- 2Look in two places: the infertility or family planning part of the covered services section, and the general exclusions list near the end.
- 3Check the plan formulary for any fertility drug you have been prescribed, or contact Oscar to confirm coverage.
- 4If you are choosing a plan for next year, read its contract before you enroll: an individual plan's fertility exclusions are in the contract, not the marketing summary.
Oscar and IVF: common questions
Does Oscar cover IVF?
Not on the individual plans we read. Oscar's evidences of coverage for Texas (2026), Florida (2026) and Georgia (2027) say the plan does not cover artificial insemination, IVF, donor eggs or sperm, or drugs and services to treat infertility. Oscar's guideline says IVF depends on the member's benefit plan, so a plan in another state can differ.
Does Oscar cover IVF in Florida?
No. Oscar's 2026 Florida individual HMO contract says it does not cover artificial insemination, IVF, donor eggs or sperm, or drugs and services to treat infertility, and it excludes freezing eggs or sperm.
Does Oscar cover infertility testing?
Yes on the plans we read: they cover diagnostic and exploratory procedures to find the cause of infertility, including surgery to correct a diagnosed condition. Treatment such as IUI, IVF and fertility drugs is not covered.
Does Oscar cover egg freezing?
Only before medical treatment that may cause infertility, and only on some plans: the Texas contract covers fertility preservation before cancer treatment, and the Georgia 2027 contract covers it with up to a year of storage. The Florida contract excludes freezing eggs or sperm.
- Oscar Managed Care Individual HMO Plan Evidence of Coverage, Texas, on-exchange (OSC-TX-IVL-HMO-EOC-2026-HIX) (Oscar, Effective Date: January 1, 2026 (plan year 2026))
- Oscar Clinical Guideline: Diagnosis and Treatment of Infertility (CG016, Ver. 14) (Oscar, Reviewed/Revised 08/01/2026)
- Oscar Health Maintenance Organization of Florida Individual HMO Evidence of Coverage, on-exchange (OSC-FL-IVL-HMO-EOC-2026-HIX) (Oscar, Effective Date: January 1, 2026 - December 31, 2026 (plan year 2026))
- Oscar Health Plan of Georgia Individual Plan Evidence of Coverage, on-exchange (OSC-GA-IVL-EOC-2027-HIX) (Oscar, Effective Date: January 1, 2027 (plan year 2027))