Access to Fertility Treatment and Care Act
Sponsored By: Representative DeLauro
In Committee
Summary
Mandates comprehensive fertility‑treatment coverage across public and private health programs. This bill would require health plans that cover obstetrical services to also cover fertility treatment — defined to include gamete and embryo preservation, artificial insemination, assisted reproductive technology (including IVF), embryo genetic testing, fertility medications, gamete donation, and related services. It would ban higher cost‑sharing for fertility care and bar incentives or rules that discourage providers from offering it.
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- Families: Private group and individual plans that include obstetrical care would have to cover fertility treatments a provider deems appropriate, with cost‑sharing no greater than for other medical services and required written notice to enrollees.
- Seniors and Medicare beneficiaries: The bill would add fertility treatment as a Medicare benefit, require Medicare to pay 100 percent of the lesser of the actual charge or the applicable payment rate, and waive the Medicare deductible for those services (effective for services on or after January 1, 2026).
- Veterans, military, federal employees, and Medicaid: The Department of Veterans Affairs, TRICARE, and the Federal Employees Health Benefits Program would follow the same standards; State Medicaid plans would be required to cover fertility treatment starting October 1, 2026, with limited processes for state delay.
The Secretary would issue interim final regulations to implement these rules without the usual notice‑and‑comment process.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 6 benefits, 0 costs, 0 mixed.
Mandatory fertility coverage in plans
If your health plan covers obstetrical care, it must also cover fertility treatment. Plans cannot charge higher deductibles, coinsurance, or copays for fertility care than for other medical services. Plans must give written notice to enrollees by the first standard mailing after interim rules, in annual packets, and at initial enrollment (but no later than January 1, 2027). These rules start for plan years that begin six months after enactment and may be delayed for group plans under certain pre-enactment collective bargaining agreements.
Medicaid must cover fertility care
States must cover fertility treatment under Medicaid starting October 1, 2026. If a State needs new state laws (other than appropriations) to comply, it gets a delay until after the next qualifying legislative session. Coverage must follow the bill's Public Health Service Act rules for fertility services.
Medicare covers fertility care
Medicare will cover fertility treatment starting January 1, 2026. Medicare pays 100% of the lesser of the provider's actual charge or the Medicare fee schedule amount for the service. The Medicare deductible will not apply to fertility treatment.
Fertility care for veterans and TRICARE
The VA must provide fertility treatment to a veteran or the veteran's spouse or partner when they apply together. The VA must write rules for the joint application within 18 months. TRICARE plans that cover obstetrical care must also cover fertility treatment, and the Defense Department will set cost-sharing consistent with the bill's parity rules.
Fertility parity for federal employees
If your Federal Employees Health Benefits plan covers obstetrical care, it must also cover fertility treatment. The plan cannot charge higher copays or deductibles for fertility care than for obstetrical benefits. These rules apply to contracts entered or renewed for contract years starting 180 days after enactment.
What counts as fertility treatment
The law defines fertility treatment to include egg, sperm, and embryo preservation; insemination; in vitro fertilization and other assisted reproductive technologies; embryo genetic testing; fertility medicines; and gamete donation. The Health Secretary can add other related services over time. This definition applies for plan years that begin six months after enactment.
Sponsors & CoSponsors
Sponsor
DeLauro
CT • D
Cosponsors
Doggett
TX • D
Sponsored 7/23/2025
Schakowsky
IL • D
Sponsored 7/23/2025
Foushee
NC • D
Sponsored 7/23/2025
Roll Call Votes
No roll call votes available for this bill.
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