Sponsors (7)
The bill substantially expands access to and reduces out-of-pocket costs for fertility care across federal programs and many private plans, but it raises significant costs and implementation burdens that may lead to higher premiums, budget pressure, uneven state-by-state access, and some eligibility exclusions.
Federal employees, military beneficiaries, veterans, Medicare and Medicaid enrollees, and people with private PHSA-regulated coverage gain mandated coverage for infertility and fertility treatments (including IVF, gamete preservation, and related medications) across FEHB, TRICARE, the VA, Medicare, Medicaid, and PHSA-governed plans.
Enrollees in covered plans (private PHSA plans, FEHB, TRICARE, Medicare, Medicaid) will generally pay no greater cost-sharing (copays, deductibles, coinsurance) for covered fertility services than for comparable obstetrical/medical benefits, reducing out-of-pocket costs for many families.
Clear federal standards, definitions, payment bases (including Medicare payment rules), and implementation timelines will create greater consistency and transparency across plans and providers, helping beneficiaries and providers understand what fertility services are covered and when.
Insurers, employers, and federal/state programs (Medicare, Medicaid, VA, FEHB, TRICARE) will face higher costs to cover fertility services, which could be passed to enrollees through higher premiums or lead to pressure on program budgets and taxpayers.
Implementing the new coverage requirements will create regulatory and administrative burdens for insurers, small employers, FEHB carriers, the DoD, VA, state Medicaid agencies, and providers (including interim rules issued without full notice-and-comment), risking transitional confusion and compliance costs.
Provider network or contracting requirements and Medicare payment-rate dynamics could limit access in some areas (especially rural communities) or lead providers to restrict services for certain patients if payment rates don't cover provider charges.
Based on analysis of 7 sections of legislative text.
Mandates parity coverage of a broad set of fertility treatments across private group plans, FEHB, DoD, VA, Medicaid, and Medicare, with cost‑sharing limits matching other medical services.
Official title: Require health insurance plans to provide coverage for fertility treatment, and for other purposes.
Introduced July 23, 2025 by Cory Anthony Booker · Last progress July 23, 2025
Requires most public and private health plans that cover obstetrical care to also cover a broad set of fertility treatments — including IVF, gamete/embryo preservation, medications, donor gametes, and related services — and to apply the same cost‑sharing rules that apply to other medical services. The bill extends these coverage requirements across federal employee plans (FEHB), TRICARE/DoD plans, VA benefits for veterans and spouses/partners, Medicaid state plans, and Medicare (which would pay 100% and waive Part B cost‑sharing for fertility services). Effective dates are phased for different programs, and the Secretary is given rulemaking authority to implement parity and nondiscrimination protections.