Does Insurance Cover Fertility Testing? Plans and States

Last updated November 12, 2026 · Reviewed by the Gala Health team

The short answer, by type of plan

The first question is not which insurer you have, but who carries the risk. State insurance laws apply to plans an insurer sells and pays for (fully insured). They do not apply to plans an employer pays for out of its own funds (self-funded), which follow federal rules instead. KFF's 2025 Employer Health Benefits Survey puts 67% of covered workers in self-funded plans, including 80% of covered workers at larger firms.

Your plan	Does a state law apply?	What that means for testing
Employer plan, fully insured	Yes, if your state has a fertility coverage law	What the law requires ranges from diagnosis only to IVF. Many laws exempt small employers and religious employers.
Employer plan, self-funded	No	Coverage is whatever your employer chose to include. The plan document, not state law, decides.
Marketplace (ACA) or individual plan	Only the state's own benefit rules	Infertility care is not one of the 10 essential health benefit categories, so federal law does not require it.
Medicaid	State Medicaid rules	KFF counts 18 states whose Medicaid programs cover some fertility services, mostly diagnosis or fertility preservation, not IVF.

Sources: KFF Employer Health Benefits Survey 2025; KFF Coverage and Use of Fertility Services in the U.S.; HealthCare.gov; KFF State Health Facts, as of November 2025.

Testing is covered more often than treatment

KFF's review of fertility coverage found that while some private plans cover diagnostic services, there is very little coverage for treatment such as IUI and IVF. That matters, because the tests that start a workup are the cheap part: the American Society for Reproductive Medicine lists a semen analysis, ovarian reserve testing such as AMH, other blood tests such as TSH and prolactin, a transvaginal ultrasound and a check that the fallopian tubes are open.

Some state laws name the tests outright. New York requires group policies to cover diagnostic tests and procedures including semen analysis, blood tests and ultrasound. Maine requires every carrier to cover fertility diagnostic care. New Jersey's law covers diagnosis and diagnostic tests in group plans with 50 or more employees.

The same plan can treat the two partners differently. His semen analysis is billed to his insurance, her bloodwork and ultrasound to hers, and if you are on different plans, you need to ask both.

Which states require fertility coverage

RESOLVE: The National Infertility Association counts 25 states with laws that provide some insurance coverage of infertility, 15 with IVF mandates and 22 with fertility preservation mandates. KFF counts 23 states that require private insurance to cover infertility services in some form. Those laws differ a lot: some cover diagnosis and IVF, some only fertility preservation before cancer treatment, some only HMOs, and Texas only requires insurers to offer IVF coverage, which employers can decline.

Our fertility insurance by state table lists every state with a law, what it covers and who is exempt. If your state is not on it, a private plan there is not required by state law to cover fertility testing, though your employer may still choose to.

What to ask your insurer: a call script

Call the member services number on your card, or ask your HR benefits team. Write down the date, the name of the person and a reference number for the call. Ask:

"Is my plan fully insured or self-funded?" (If self-funded, state mandates do not apply; ask for the plan document instead.)
"Does my plan cover the diagnosis of infertility, for me and for my partner?"
"Are these tests covered: AMH (CPT 82166), semen analysis (CPT 89320) and a transvaginal pelvic ultrasound (CPT 76830)?"
"Do I need a diagnosis of infertility first, for example 12 months of trying, or 6 months if I am 35 or older?"
"Do I need a referral or prior authorization, and does it have to come from a specific type of doctor?"
"Which labs and imaging centers are in network?"
"What will I pay: is it subject to my deductible, and what is the copay or coinsurance?"
"Is there a separate fertility benefit or a lifetime maximum?"

Ask for the answer in writing if it is yes. A phone answer is not a coverage decision, and what is paid can depend on how the visit and tests are coded.

CPT codes as described by FeeBase from the CMS fee schedules. The 12-month and 6-month thresholds come from ASRM's definition of infertility.

If your plan says no

Use pre-tax money. IRS Publication 502 counts laboratory fees that are part of medical care, and fertility procedures such as IVF, as medical expenses, and Publication 969 ties HSA qualified expenses to that definition. Several direct-to-consumer labs list HSA and FSA cards as accepted.
Compare cash prices. On the price lists we checked, an AMH test cost $78 to $141 and a semen analysis $145 to $295. See AMH test cost, semen analysis cost and how much fertility testing costs.
Ask your employer. If your plan is self-funded, HR decides what it covers, and RESOLVE publishes guidance for asking an employer to add coverage.
Check when to test. Many state laws define infertility as 12 months of trying, or 6 months at 35 or older, before coverage applies. See how long to try before fertility testing.

Skip the insurance maze: Gala Fertility

Gala Fertility does not need your insurer to say yes. It checks both partners in one program, and one price covers the tests:

Her bloodwork at a Quest lab, including AMH, and preconception screening
Her pelvic ultrasound at a location near you
His semen analysis with a kit sent home, and his bloodwork if your clinician indicates it
Every result reviewed, then explained on one video visit together
Medication each cycle if prescribed, a check-in after every cycle and messages with your care team

You start with a $29.99 introductory video meeting with the care team, credited to your first payment if you join the program. The medical team is led by Medical Director Dr. Joshua Klein, MD, FACOG, a board-certified reproductive endocrinologist. See how fertility testing for couples works, or go back to Gala Fertility. Ready? Start together.

Frequently asked questions

Does insurance cover fertility testing?

Sometimes. It depends on whether your plan is fully insured or self-funded and on your state. Private plans cover diagnostic testing more often than IVF, but state laws only apply to fully insured plans, and most covered workers are in self-funded plans.

Does insurance cover a semen analysis?

It can, when it is ordered to diagnose infertility and your plan covers infertility diagnosis. It is billed to the male partner's insurance. New York, for example, requires group plans to cover semen analysis as a diagnostic test.

Does insurance cover an AMH test?

It may, as part of an infertility workup, if your plan covers diagnosis. Ask about CPT code 82166. Without coverage, the AMH prices we checked ran $78 to $141.

Do ACA marketplace plans cover fertility testing?

Federal law does not require it. Infertility care is not one of the 10 essential health benefit categories, so it depends on your state's rules and the specific plan.

How do I know if my plan is self-funded?

Ask your HR or benefits team, or the member services line on your card. Self-funded plans are often administered by a big insurer, so the logo on the card does not tell you who funds the plan.

Can I use my HSA or FSA for fertility testing?

Generally, yes. IRS Publication 502 counts laboratory fees that are part of medical care as medical expenses, and HSA qualified expenses follow that definition. Check with your plan administrator.

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Your answers go to a licensed provider, who decides whether treatment is right for you. Learn more about Gala Fertility.

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Sources

This article is for general information and is not medical advice. Talk to a licensed provider about your own health.

Does Insurance Cover Fertility Testing? Plans, States and What to Ask