Infertility & Menopause Coverage
One of our most frequently asked questions at The Insurance People is how infertility and menopause coverage work. There are a lot of elements to consider, and recent changes in legislation that add to the confusion. Not to fear though, your insurance moms are here to walk you through what your insurance can do for you when it comes to all things fertility and menopause.
For women over 45 going through menopause, one annual visit for menopause health is covered as a preventative service. This visit may be in addition to their annual routine exam as well. This coverage was introduced by Illinois Senate Bill 773 and went into effect as of 2026. Unfortunately, in spite of the rise in popularity of hormonal therapy to ease menopause symptoms, hormone therapy for menopause is generally not covered by insurance. However, alternative treatment methods may be covered by your plan, so it is best to discuss multiple options for managing your symptoms with your provider.
FDA-approved methods of birth control prescribed by a doctor, such as barrier methods, hormonal methods, implant devices, emergency contraception, and sterilization, have long been covered by insurance without coinsurance or copayment charges.
Infertility coverage is a bit more complicated. Illinois Senate Bill 773 also amended and extended coverage for a variety of fertility procedures, such as surgical sperm extraction, low tubal ovum transfer, and intracytoplasmic sperm injection. Coverage also already covers up to three rounds of IUI and/or four rounds of IVF, but has been amended so that folks no longer have to prove that they tried to conceive naturally prior to fertility treatment.
While extraction, injection, and implantation procedures are covered by insurance, the freezing and storage of eggs, sperm, and embryos is not. Additionally, prenatal genetic testing is not covered, unless it is deemed medically necessary due to a history of genetic disorders or if deemed high risk. If you are unsure if you qualify, get in touch with us! We are happy to assess your situation and go over what you can expect to be covered.
Women’s healthcare has come a long way over the past several years, and legislation is continuing to expand coverage. While there currently exist entities threatening to reduce or restrict access to women’s healthcare, it is increasingly important to understand your rights and coverage options. There are a lot of possibilities available to support you in your reproductive and menopause journey, and your insurance moms are here to help you understand your options every step of the way. If you are ever unsure what your coverage may include, don’t hesitate to reach out!
