Access to Fertility Treatment and Care Act
- Sponsor
- Rep. DeLauro, Rosa L. [D-CT-3]
- Committees
- Veterans' Affairs Committee (primary)
- Last action
- Dec 19, 2025
Bottom line
The "Access to Fertility Treatment and Care Act" aims to significantly expand access to fertility treatments across various health insurance programs by mandating comprehensive coverage and limiting cost-sharing.
What it actually does
This bill mandates that all group health plans and individual health insurance coverage that provide obstetrical services must also cover fertility treatment. It defines fertility treatment broadly to include preservation of genetic material, artificial insemination, assisted reproductive technology (like IVF), genetic testing of embryos, medications, and gamete donation. The bill extends this requirement to the Federal Employees Health Benefits Program, TRICARE, Medicaid, and Medicare, and also requires the VA to furnish fertility treatment services to veterans and their spouses/partners.
Proponents argue
Proponents argue that fertility treatment is essential healthcare, not an elective procedure, and that current insurance gaps create significant financial burdens and inequities for individuals and couples seeking to build families. They contend that mandating coverage will make these treatments accessible to a broader population, aligning with principles of comprehensive healthcare and reproductive autonomy.
Opponents contend
Opponents may raise concerns about the potential increase in healthcare premiums for all insured individuals, arguing that mandating such extensive coverage could drive up costs. Some may also express ethical concerns regarding certain fertility treatments, particularly those involving genetic testing of embryos or gamete donation, or question the role of federal mandates in private insurance decisions.
The bill is moderately complex due to its numerous statutory amendments, but its core provisions are clearly stated, making it accessible for an informed reader to evaluate within a reasonable timeframe.
Section 2(a)(1), (2), (3) amending PHSA, ERISA, IRC (new sections 2799A-11, 726, and 9826)
Required Fertility Treatment Coverage for Private and Group Health Plans
This provision mandates that any group health plan or individual health insurance coverage that already covers obstetrical services must also provide coverage for fertility treatment. It specifies a broad definition of fertility treatment, including IVF, genetic testing of embryos, gamete donation, and preservation of reproductive materials, without requiring an infertility diagnosis.
Supporters argue
Supporters argue this ensures equitable access to family-building options, removing financial barriers that disproportionately affect certain demographics and promoting health equity.
Critics contend
Critics may contend that this mandate will increase premiums for all policyholders, including those who do not utilize fertility services, potentially making healthcare less affordable overall.
Tradeoffs
Balances the desire for comprehensive healthcare access against concerns about rising insurance costs and the scope of federal mandates on private industry.
Section 2(a)(1)(D), (2)(D), (3)(D) amending PHSA, ERISA, IRC
Equal Cost-Sharing for Fertility Treatment
This provision prohibits imposing cost-sharing (deductibles, coinsurance) or other limitations on fertility treatment that exceed those applied to other medical services under the same plan. It allows for more favorable limitations for fertility treatment.
Section 3(a) amending 5 U.S.C. 8902
Fertility Treatment Coverage for Federal Employees Health Benefits (FEHB) Program
This section requires contracts under the FEHB program to provide coverage for fertility treatment, consistent with the standards set for private plans, if the contract covers obstetrical benefits. It also caps copayments and deductibles for fertility treatment at levels no greater than those for obstetrical benefits.
Section 4(a) adding new section 1110c to 10 U.S.C. Chapter 55
Fertility Treatment Coverage for TRICARE Program
This section mandates that TRICARE health care plans provide coverage for fertility treatment, mirroring the standards and cost-sharing requirements set for private plans, if the plan covers obstetrical benefits. The Secretary of Defense is tasked with prescribing necessary regulations.
Section 5(a) adding new section 1720M to 38 U.S.C. Chapter 17
VA Furnishing Fertility Treatment to Veterans and Partners
This provision requires the Secretary of Veterans Affairs to furnish fertility treatment services to veterans and their spouses or partners, provided they apply jointly through a prescribed process. The definition of fertility treatment aligns with the broader bill.
Section 6(a) amending 42 U.S.C. 1396d
State Medicaid Plans to Cover Fertility Treatment
This section amends the Social Security Act to require State Medicaid plans to provide medical assistance for fertility treatment, aligning with the requirements and limitations (including definition and cost-sharing) set for private health insurance.
Section 7(a) amending 42 U.S.C. 1395x(s)(2)
Medicare Coverage for Fertility Treatment
This section adds fertility treatment to the list of services covered by Medicare Part B. It also waives coinsurance and deductibles for fertility treatment, ensuring 100% coverage after the payment basis is determined.
The bill provides a comprehensive definition of "fertility treatment" that includes preservation of oocytes, sperm, or embryos; artificial insemination; assisted reproductive technology (including IVF); genetic testing of embryos; medications; gamete donation; and other services determined appropriate by the Secretary.
Section 2(b) (and cross-referenced throughout the bill)
Why it matters:It is standard legislative practice to define terms early, but the comprehensive nature and discretionary power granted to the Secretary could be significant.
Case for: Proponents argue that a broad definition is necessary to ensure comprehensive and evolving care, reflecting modern medical advancements in fertility treatment and allowing for future flexibility.
Case against: Opponents might argue that the broad definition, especially the inclusion of genetic testing of embryos and gamete donation, raises ethical questions for some and could lead to unforeseen costs or services not universally supported.
Estimated impact: Significantly expands the scope of covered services beyond basic fertility consultations, potentially increasing the cost and complexity of implementation.
The bill explicitly states that coverage for fertility treatment must be provided "regardless of whether the participant, beneficiary, or enrollee receiving such treatment has been diagnosed with infertility as defined by the American Society for Reproductive Medicine."
Section 2(c) (and cross-referenced in other sections)
Why it matters:This is a key policy decision that might be technically phrased. It's not necessarily evasive but could be missed.
Case for: Proponents argue this prevents arbitrary barriers to care, recognizing that fertility challenges can exist without a formal diagnosis of "infertility" (e.g., for single individuals, LGBTQ+ couples, or those seeking family planning due to medical necessity like cancer treatment).
Case against: Opponents might argue that this broadens the scope of coverage beyond what is medically necessary for a diagnosed condition, potentially increasing costs for elective procedures.
Estimated impact: Significantly expands the pool of eligible individuals beyond those with a clinical infertility diagnosis, increasing the utilization and cost of services.
The Secretary "shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code."
Section 2(d) (PHSA, ERISA, IRC versions)
Why it matters:This is standard language for urgent implementation, but it bypasses public input.
Case for: Proponents argue that waiving notice and comment allows for rapid implementation of critical cost-sharing protections, ensuring beneficiaries receive equitable treatment without undue delay.
Case against: Critics might argue that bypassing standard notice and comment procedures reduces transparency and public accountability, potentially leading to regulations that are not fully vetted or that have unintended consequences.
Estimated impact: Accelerates the regulatory process for cost-sharing rules, potentially impacting how quickly plans must adjust their offerings.