Access to Fertility Treatment and Care Act
The Access to Fertility Treatment and Care Act would make fertility treatment a covered benefit under a wide range of federal health programs and, for private plans, under the same standard as obstetrical care. It defines fertility treatment to include services from preserving eggs/sperm/embryos and various forms of artificial insemination to assisted reproductive technology (including IVF), genetic testing of embryos, medications for fertility, and related services. The bill ties coverage to plans that already cover obstetrical services, requires state and federal programs to cover fertility treatments when appropriate, and imposes cost-sharing rules to ensure parity with other medical services. It also prohibits certain practices intended to discourage or penalize fertility treatment and requires clear notice to enrollees about coverage. The bill would roll out in stages across various programs (the Public Health Service Act, ERISA, Internal Revenue Code, FEHB, TRICARE, Veterans programs, Medicaid, and Medicare) with specific effective dates and some transitional provisions for collective bargaining plans. In short, the bill aims to expand access to fertility care by requiring comprehensive coverage, standardizing what counts as fertility treatment, controlling cost-sharing, protecting patients and providers from discrimination or penalties, and extending these standards across numerous federal programs and, through alignment with private plans, potentially influencing private market practice.
Key Points
- 1Coverage mandate and definitions
- 2- Requires group health plans and health insurance issuers that cover obstetrical services to also cover fertility treatment, defined to include preservation of gametes/embryos, various forms of insemination, ART (including IVF), genetic testing of embryos, fertility medications, gamete donation, and related services as determined appropriate by the Secretary.
- 3- Coverage applies when the treatment is prescribed at a compliant medical facility and deemed appropriate by a health care provider, regardless of whether the patient has a formal infertility diagnosis.
- 4Cost-sharing and protections
- 5- Prohibits higher deductibles, coinsurance, or other less-favorable cost-sharing for fertility treatment compared with other medical services (or at minimum parity with those services).
- 6- Prohibits incentives to discourage fertility treatment, protects provider-patient discussions about fertility options, prohibits penalizing providers for delivering fertility care, and prohibits discrimination in coverage based on protected statuses.
- 7Notice and administration
- 8- Requires written, prominently displayed notice to participants about the coverage, with specified timing (including by January 1, 2027, for initial communications) and ongoing annual updates.
- 9- Allows the Secretary to issue interim final regulations to implement these notice and cost-sharing rules.
- 10Cross-cutting federal coverage (PHSA, ERISA, and IRC)
- 11- The standards are implemented across the Public Health Service Act (PHSA), the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code (IRC), creating parallel requirements for federal employee plans, private employer-sponsored plans, and tax-advantaged arrangements.
- 12Expanded program-by-program implementation
- 13- Federal Employees Health Benefits Program (FEHBP): mandates fertility treatment coverage with parity to obstetrical benefits; applies after a six-month period post-enactment.
- 14- TRICARE: requires obstetrical coverage and fertility treatment for military health plans, with cost-sharing rules aligned to the PHSA standards.
- 15- Veterans Affairs (VA): adds a new fertility treatment benefit for veterans and their spouses/partners, with a regulated implementation timeline.
- 16- Medicaid: states must ensure Medicaid medical assistance for fertility treatment complies with the standard set in 2799A-11, with phased effective dates and a state-flexibility provision if legislation is required.
- 17- Medicare: expands coverage to include fertility treatment (defined in the bill) and adjusts payment structures (including waivers of certain deductibles and setting payment to the lower of charges or standard payment rates) beginning in 2026.
- 18Effective dates and implementation caveats
- 19- Most amendments apply to plan years beginning six months after enactment, with a collective bargaining exception for plans under ongoing agreements.
- 20- FEHBP, Medicaid, TRICARE, VA, and Medicare/Medicaid-related provisions include specific staggered effective dates (e.g., 180 days for FEHBP, 2026 for Medicare, and 2026 for Medicaid-related requirements, subject to state legislative timelines).
- 21Definitions and scope
- 22- The bill’s fertility treatment definition covers a broad range of services and technologies, including cutting-edge and traditional fertility care, with authority for the Secretary to add related items as appropriate.