Advocates, Employers Urge Trump to Address Costs in IVF Plan

The Trump administration’s proposal to let employers cover fertility care via standalone plans doesn’t address the central problem with coverage—cost—raising questions about whether the rule will increase options for workers struggling to start a family.

The administration last week proposed a rule that would let employers carve out fertility benefits through “limited excepted benefit” plans, which are exempt from a number of federal insurance requirements. Limited excepted benefit, or standalone, plans are also traditionally used to cover benefits such as dental and vision.

Roughly two-thirds of employers don’t offer fertility coverage, according to the Health and Human Services, Labor, and Treasury departments. The proposal would give employers freedom to cover a range of fertility benefits up to $120,000 in value, and solicits comments on extending similar flexibility to plans in the individual market.

The rule follows an executive order President Donald Trump signed in February 2025 aimed at “protecting IVF access and aggressively reducing out-of-pocket and health plan costs.” The order came after the Alabama Supreme Court ruled that fetuses are people under the state’s wrongful death law, triggering a scramble to keep IVF clinics from closing.

The proposed rule falls short of Trump’s campaign promise to implement universal coverage of IVF, but also avoids angering the right wing of the Republican Party that harbors religious objections to the procedure. It’s a middle ground that experts say has limited upside, considering that employers already have the ability to offer fertility benefits in several ways.

“While it’s an incremental step in the right direction, this is not what the president promised when he was running,” said Sean Tipton, chief advocacy and policy officer with the American Society of Reproductive Medicine. “He said free accessible IVF for everyone. This policy is not going to achieve that.”

A Department of Labor official said the rule was one piece in a multi-faceted approach to improve fertility care. The president’s self-branded drug discount site, TrumpRx, also features three discounted fertility medications, highlighting how the site—which Trump expanded to include generics through the Mark Cuban Cost Plus Drug Company—could be helpful to consumers.

But the broad flexibility could create a lot of variation that will be confusing, said Danielle Melfi, CEO of RESOLVE: The National Infertility Association. She urged the administration to outline basic coverage guardrails.

“Until you have a diagnosis and you’re navigating your own treatment journey, we are so under-educated about what treatments are available, what proactive resources like egg freezing are available,” she said.

Cost Concerns

Fertility benefits are a key hiring and retention tool for employers, said Jenny Goins, chief of staff for the National Alliance of Healthcare Purchaser Coalitions.

“I know from experience in talking to employees, they will shop for fertility benefits,” she said. ”They will go to the employer that has those fertility benefits.”

But escalating costs are the top concern for employers, she said, citing one member facing a 17% increase in insurance expenses next year. One round of IVF can cost between $15,000 and $30,000.

“The flexibility is awesome,” she said of the rule. “But it’s not helping contain cost.”

Roughly a quarter of employers with 200 or more employees offer IVF, according to healthcare think tank KFF. Many cover fertility treatments through their traditional health plan. Employers can also offer workers money for fertility treatments through health reimbursement arrangements, said Jennifer Rigterink, who helps employers design family building benefits as a senior counsel with Proskauer Rose LLP.

Client concerns typically center on cost, not current regulations, she said.

“There’s more flexibility, but if an employer is already struggling to offer major medical coverage because of cost, I’m just interested if they will want to offer what could be an expensive benefit,” she said.

Larger employers currently offering coverage won’t likely shift to standalone plans. Sixty-four percent of NAHPC members already offer fertility coverage, Goins said, and more are considering adding it.

“I would think they will choose to keep it within their benefits,” she said. “They’re not going to go out of their way to make it a limited excepted benefit.”

Questions

The departments predict additional flexibility under the rule will double the number of employers covering fertility care from 268,000 to 523,000. But even if that happens, it’s unclear how comprehensive additional benefits would be.

Standalone fertility plans would face more complex pricing calculations than dental or vision plans, which have broad enrollment akin to a traditional medical plan. Enrollment in fertility plans, by contrast, would likely be limited to people who already know they need the care. That means expenses for pricey fertility services would be spread across far fewer enrollees, increasing premiums—although the departments are considering whether to prohibit employers from charging premiums and cost-sharing.

And even though the proposal doesn’t dictate what services can or can’t be covered, questions still exist around limitations. The line between infertility treatments and more general family planning services—like egg freezing, for example—is not clear.

Whether services can be covered on a pre-tax basis is also determined by the IRS, which doesn’t always view egg freezing as a qualified medical expense.

“Will long-term fertility preservation that hedges against the risk of future infertility be covered?” Rigterink said.

Standalone plans without baseline coverage guidance risk creating a two-tiered system, Melfi said, noting that most benefits are structured around benefit limitations, such as IVF cycles, rather than a dollar limit.

“Because infertility is a disease, it deserves to be treated as such,” she said.

Regardless of how the final rule ultimately turns out, employers have always had the option to cover fertility care, Tipton stressed.

“I have never heard an employer say, ‘I would offer fertility coverage but there’s too many rules in traditional health insurance and that keeps me from doing it,’” he said.