Capstone believes the US fertility market is well-positioned amid increased state and federal action on in vitro fertilization (IVF) policy and access. Recent guidance from the Trump administration may empower employers to expand access to fertility benefits; however, final decision-making powers presently rest with the states and individual employers, who determine whether and how to follow the executive guidance.
- On October 16, the Trump administration released guidance encouraging employers to offer standalone fertility benefits similar to dental or vision coverage, though adoption remains voluntary. The announcement followed an executive order in February 2025 that directed the development of policy recommendations to expand IVF access.
- Capstone believes the administration’s guidance promoting IVF access represents a tailwind for the fertility industry. However, recent momentum at the federal level, while promising, is not sufficient to signal a sweeping removal of structural barriers to IVF access, as much of the responsibility for coverage lies with states and private employers.
- While there have been efforts to introduce bills at the federal level to improve IVF access, Capstone believes state legislatures are the locus of future concrete action at the state level and that legislative solutions at the federal level from Congress are unlikely. As state-led coverage mandates generally increase demand for and utilization of fertility benefits, Capstone expects significant upside for entities providing IVF services, particularly in states with stronger mandates.
Trump Executive Order
On October 16, the Trump administration unveiled a dual-pronged approach to expand IVF access through a pharmaceutical pricing agreement and new employer coverage guidance. The announcement included a drug-pricing deal with EMD Serono to reduce the cost of its fertility medication and federal guidance allowing employers to offer fertility benefits as standalone coverage, similar to dental or vision insurance. The effort combines two Trump priorities: lowering drug prices and making IVF treatment more affordable, as roughly a quarter of employers report covering IVF for their workers. The administration framed these initiatives as supporting family formation, even as US fertility rates have reached historic lows.
Coverage
The Departments of Labor, Health and Human Services, and Treasury issued joint guidance on October 16, clarifying how employers may offer fertility benefits as ‘excepted benefits’ under existing regulations, a designation that exempts them from specific Affordable Care Act (ACA) and Health Insurance Portability and Accountability Act (HIPAA) requirements. Under this new benefit option, employers will have a legal pathway to offer fertility benefits directly to employees, such as dental, vision, and life insurance, thereby expanding access to IVF coverage. Notably, the guidance does not require employers to offer fertility benefits, and a senior administration official acknowledged it would take time for interested employers to implement the option.
The guidance provides a pathway for employers to offer standalone fertility benefits voluntarily, similar to dental or vision coverage, though without mandates or financial incentives, adoption will likely remain limited. The administration’s commitment to additional rulemaking signals recognition that the current framework may not be sufficient to meaningfully expand employer participation, though the timeline, scope, and specific policy levers remain undefined. Capstone expects the immediate impact on fertility coverage to be modest, as voluntary guidance typically drives slower adoption than mandated coverage, and many employers already offering fertility benefits can utilize existing structures without this guidance.
Overview of Federal Support for IVF Treatment
President Trump’s most recent executive order regarding IVF confirms Capstone’s belief that support for fertility services and IVF is becoming increasingly bipartisan at the federal level (see “In Vitro Fertilization Market Poised for Growth as Fertility Care Finds Bipartisan Support, Pushing States to Start or Expand Coverage Mandates,” September 24, 2024). In recent years, several lawmakers on both sides of the aisle have introduced legislation to federally mandate employers’ coverage of IVF. While most efforts to expand IVF coverage occur at the state level, the federal government has increasingly supported expanded IVF access, becoming more active in promoting visible policy initiatives focused on fertility care. Notable federal pro-IVF legislation includes the Right to IVF Act (S 4445), ultimately blocked by Senate Republicans in September 2024, which would have expanded and protected fertility treatment at the federal level, and the HOPE with Fertility Services Act (HR 8821), which would require employer-sponsored plans to cover IVF for medically induced infertility. The bipartisan bill stalled in committee last year and would need to be reintroduced in Congress. Although there are some Republican efforts and bipartisan support for certain bills, their support to date has not been as robust as that coming from Democrats.
Additional bills introduced this year include the Democratic-sponsored Protect IVF Act (S 2035) and the Republican-sponsored IVF Access and Affordability Act (HR 1878). While both bills are intended to expand access to IVF, the former seeks to codify the right to fertility treatment in federal law, while the latter aims to expand access by introducing tax credits to offset out-of-pocket costs for IVF services. Both bills have been referred to their respective committees, and Capstone will continue to track their progress.
Beyond proposed legislation, there has been a significant expansion of IVF coverage at the federal level in the last two years. For 2025, the Federal Employees Health Benefits (FEHB) Program offered expanded IVF access to federal workers and their beneficiaries, covering 8 million people. The expansion, which allowed FEHB enrollees to choose a plan with fertility benefits, mandated that every state offer at least two plan options for IVF coverage and to cover medications needed for up to three cycles of IVF. Likewise, in 2024, the Department of Veterans Affairs expanded its IVF coverage to include eligible veterans regardless of marital status or sexual orientation. IVF coverage is still limited to veterans who require IVF services due to a health condition caused directly by their military service. While this expansion of IVF coverage signals a significant shift in federal fertility policy, interventions are focused on federal workers and military veterans; there remains no universal mandate for private insurers or public payor coverage.
The Trump administration’s recent guidance builds on growing federal action regarding IVF policy and access. Capstone believes that further executive-level efforts to expand IVF benefits only add to existing favorable macro tailwinds for the fertility market. However, even as federal engagement increases, the material impact of expansion largely falls to the states and individual employers to determine whether and how to follow executive guidance.
Exhibit 1: Timeline of Trump Administration Action on IVF Access Expansion
| Date | Federal Action |
|---|---|
| 2/18/2025 | President Trump signed Executive Order “Expanding Access to In Vitro Fertilization.” |
| 3/05/2025 | IVF Access and Affordability Act (H.R. 1878) introduced. |
| 4/01/2025 | IVF for Military Families Act (S. 1231/H.R. 2557) introduced. |
| 5/19/2025 | Health Coverage for IVF Act of 2025 (H.R. 3480) introduced. |
| 6/11/2025 | Protect IVF Act (S. 2035) introduced. |
| 10/16/2025 | EMD Serono pricing deal and employer guidance to facilitate IVF coverage announced. |
Additional State IVF Coverage Mandates Likely In the Next Five Years
Capstone believes at least 10 states are likely to pass IVF coverage mandates in the next five years, adding to the existing 22 states plus DC that have already passed mandates. Numerous states across the US have multi-year histories of introducing bills that would establish IVF coverage mandates or support fertility services accessibility, indicating widespread support for IVF treatments. However, IVF coverage mandate bills’ primary obstacle is IVF’s lack of urgency compared to other issues, particularly in recent legislative sessions. Most mandate bills have died in committee rather than failing on the voting floor, indicating a lack of prioritization rather than active opposition. In most states, mandate bills go to the respective states’ health committees or ways and means committees, both of which are highly influential and busy. Thus, coverage mandate bills often sit in committee until the legislative session ends. However, several states have coverage mandates for fertility preservation treatments or established legal protections for IVF, indicating support for fertility services that could manifest in IVF coverage mandates over the next few years.
Exhibit 2: Non-IVF coverage mandate states considering pro-IVF legislation
| State | Years Introduced | Bills’ Proposed Actions |
|---|---|---|
| Louisiana | 2022, 2023, 2025 | 2022: Mandate IVF coverage 2023: Mandate fertility preservation coverage (passed) 2025: Legal protections for IVF treatments (passed) |
| Michigan | 2024 | 2024: Mandate IVF coverage 2024: Legal protections for IVF treatments (passed) |
| Minnesota | 2023, 2025 | 2023, 2025: Mandate IVF coverage |
| Montana | 2023, 2025 | 2023: Mandate fertility preservation coverage (passed) 2025: Mandate IVF coverage |
| Oklahoma | 2022, 2024 | 2022: Legal protections for IVF treatments 2025: Mandate IVF coverage |
| Oregon | 2019, 2021, 2022, 2023, 2025 | 2019: Mandate infertility coverage, potentially IVF 2021, 2022, 2023, 2025: Mandate IVF coverage |
| Pennsylvania | 2023, 2025 | 2023, 2025: Mandate IVF coverage |
| Tennessee | 2025 | 2025: Mandate IVF coverage 2025: Legal protections for IVF treatments (passed) |
| Washington | 2022, 2023, 2024, 2025 | 2022, 2023, 2025: Mandate IVF coverage 2024: Provide legal protection for infertility treatments |
| Wisconsin | 2021, 2023 | 2021, 2023: Mandate IVF coverage |
| Virginia | 2020, 2022, 2023, 2024, 2025 | 2020, 2022, 2023, 2024: Mandate IVF coverage 2025: Assess IVF for Essential Health Benefits (passed) |
What’s Next
Capstone will continue to monitor the passage of IVF coverage mandates at the state level alongside catalysts to their passage. Capstone will also monitor federal action from the Trump administration or Congress regarding IVF insurance coverage.
