In this section, we’ll review the fundamental aspects of health insurance plans that are common in the United States. Note that this information may not directly apply to your personal plan, so it’s important to verify details with your plan administrator or HR department.
Unfortunately, most Americans do not have comprehensive fertility coverage. Even when fertility care is included, there are often strict limitations on what’s covered. However, there are ways to make the most of your existing insurance — and this section will help you understand how.
Before diving into fertility-specific details, let’s start with a few key health insurance terms.
This is the base cost you pay for your health insurance. It may be deducted automatically from your paycheck if you have employer-sponsored insurance or paid directly to your insurer if you’re self-insured. The premium doesn’t include additional costs such as deductibles, copayments, or coinsurance.
The deductible is the amount you must pay out-of-pocket for approved medical services before your insurance starts contributing. Some plans have separate deductibles for prescription medications. Generally, lower deductibles come with higher monthly premiums, while higher deductibles mean lower premiums.
For example, let’s compare two patients with fertility treatment costs of $4,000 for IUI — one with a low deductible and another with a high deductible. You’ll see how this difference impacts the amount they pay upfront before insurance coverage begins.
Coinsurance refers to the percentage of healthcare costs you pay after meeting your deductible. For instance, if your plan covers 80% of expenses, your coinsurance responsibility would be 20%.
Consider how two patients with differing coinsurance levels (20% vs. 50%) might pay different amounts even if both have fertility benefits through their employers.
Many plans also differentiate between in-network and out-of-network providers — with lower coinsurance rates for in-network care.
Most insurance plans exclude fertility treatment altogether, while others provide a maximum coverage limit, known as a “cap.” This cap is often a lifetime maximum, meaning it doesn’t reset yearly. For example, a $50,000 lifetime cap versus a $10,000 cap can drastically affect what patients pay out-of-pocket for procedures like IVF.
If a patient’s total IVF expenses reach $60,000 (roughly three treatment cycles), those with higher coverage caps will pay significantly less after meeting their deductible. The difference can be financially life-changing.
This is the maximum amount you would pay during a plan year for covered services. After meeting this limit (through deductibles, copayments, and coinsurance), your insurance covers 100% of eligible costs. Note: this number does not include your monthly premium, which you must still pay.
A copay is a fixed amount you pay for specific healthcare visits after meeting your deductible — for example, $20 for a primary care visit or $50 for a specialist. While copays are predictable, they are generally less significant compared to larger factors like deductibles and coinsurance in determining total fertility costs.
Both your deductible and maximums reset annually, so planning your treatment timing around your insurance year can help reduce costs — a topic we’ll cover more in the next section.
Even if employers don’t directly cover fertility care, many offer Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) — both allow you to use pre-tax dollars to pay for eligible medical expenses, including most fertility treatments.
An HSA lets you save pre-tax income for medical expenses. The funds remain yours indefinitely and roll over each year, making it a good long-term savings tool.
An FSA also uses pre-tax income, but funds must be used within the same calendar year (“use it or lose it”). Some FSAs are designated solely for healthcare expenses, while others can be used for additional eligible costs.
Example:
If you earn $50,000 annually and pay 25% in taxes, you’d take home $37,000 for expenses. But if you contribute $5,000 to an HSA or FSA, your taxable income drops to $45,000. After taxes, you’d keep $38,750 — plus $5,000 specifically reserved for medical care.
The difference: you save money while earmarking funds for treatment.
Note: The IRS sets annual contribution limits for HSAs and FSAs. Consult a tax professional to determine the best approach for your situation.
Once you understand your plan’s basics (deductible, coinsurance, etc.), talk to your HR or benefits administrator to clarify fertility coverage. Employers must provide a Summary of Benefits and Coverage document detailing what is — and isn’t — covered.
Fertility care generally involves two stages:
Diagnosis (e.g., bloodwork, ultrasounds)
Treatment (e.g., IUI, IVF)
Coverage depends on:
Your plan’s specific terms
Your fertility-related diagnosis
Prior treatments or test results
Often, even plans that exclude treatment will cover diagnostic testing — particularly if done through an in-network OB-GYN, which can save hundreds.
Some policies restrict treatment coverage based on diagnosis or age, approving care only when success likelihood and medical justification are strong.
Example:
Plan #1: Covers “diagnosis and treatment.”
Plan #2: Covers only when infertility is due to disease or dysfunction — excluding single parents, LGBTQ+ individuals, and elective preservation patients.
Plan #3: Includes “basic infertility services,” usually limited to testing.
Plan #4: May cover oral fertility drugs or IUI, but not IVF or surrogacy.
Fertility medications can cost $3,000–$10,000 per IVF cycle. Some plans that exclude IVF still cover basic oral drugs, while others include medications within a total fertility cap or offer separate prescription coverage.
Policies usually require you to use in-network pharmacies, with coinsurance rates similar to treatment coverage. Always confirm how your plan handles prescription fertility drugs before starting treatment.
Many insurers require pre-authorization — an approval process confirming eligibility before treatment. It helps the insurer ensure you’re using an in-network clinic or have met prerequisites (like completing a set number of IUIs before IVF).
The complexity of pre-authorization varies by plan and depends on the documentation available about your age, diagnosis, or treatment history.
Even when fertility coverage exists, it often applies only to specific cases. Below are examples of common exclusions:
Covered Individuals – Some plans limit benefits to married or legally recognized partners, excluding single patients or those using donors or surrogates.
Proof of Attempted Conception – Many plans require evidence of failed conception attempts (e.g., 6–12 IUIs) before IVF, excluding single men or same-sex male couples.
Age Restrictions – Coverage may end at certain ages, often focusing on female egg quality. Some also restrict treatment using donor eggs beyond certain maternal age thresholds.
Many insurance policies exclude services involving third parties — such as donor egg retrieval, donor sperm preparation, or embryo transfers to a gestational surrogate. Some policies state this outright; others omit it, which usually implies no coverage applies.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
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