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Exploring IVF Insurance Coverage in Chicago and Illinois

Paying for fertility treatment is one of the most stressful parts of starting or growing a family, and because most health insurance is provided through an employer, the path to coverage usually begins at work. The good news for patients in Chicago and across Illinois: this state has one of the most patient-friendly fertility coverage mandates in the country, and a new law that took effect on January 1, 2026 made it even stronger.

This guide explains how IVF and fertility insurance coverage works in Illinois today, what changed in 2026, how to talk to your employer and your insurer, and how the new federal TrumpRx medication program fits in. If you’d like a step-by-step look at what AFCC accepts and how our financial team can help, you can also visit our Fertility Insurance & Benefits page.

The Illinois Fertility Coverage Mandate: A Brief Overview

Illinois is one of a small group of states with a fertility insurance mandate, and the rules became significantly more inclusive on January 1, 2026 when Public Act 103-0751, also known as the “Castro Law,” took effect. 

What Illinois Law Requires Today (effective January 1, 2026)

Under the updated Illinois Insurance Code, every group health insurance policy issued, amended, delivered, or renewed in Illinois that provides pregnancy-related benefits must now also cover the diagnosis and treatment of infertility, regardless of the size of the employer.

Covered services include, but are not limited to:

• Diagnosis of infertility

• In vitro fertilization (IVF)

• Embryo transfer, including frozen embryo transfer (FET)

• Intrauterine insemination (IUI) / artificial insemination

• Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT)

• Intracytoplasmic sperm injection (ICSI)

• Surgical sperm extraction (newly enumerated under the 2026 update)

• Preimplantation genetic testing (PGT), including testing for aneuploidy and structural rearrangements

Coverage for IVF, GIFT, and ZIFT applies once a patient has been unable to achieve or sustain a pregnancy through reasonable, less costly fertility treatments covered by insurance, unless attempting those steps would be medically inappropriate. Procedures must also be performed at facilities that meet the American College of Obstetricians and Gynecologists (ACOG) and American Society for Reproductive Medicine (ASRM) standards. AFCC meets these requirements.

How Illinois Defines Infertility

Illinois law defines infertility as the failure to establish or carry a pregnancy to live birth after:

• 12 months of regular, unprotected intercourse if the patient is 35 or younger, or

• 6 months if the patient is over 35

Importantly, the definition also covers a person’s inability to reproduce either as a single individual or with a partner without medical intervention. This language supports access for single patients and LGBTQ+ patients under qualifying plans, and is one of the reasons Illinois is considered a national leader in inclusive fertility coverage. You can learn more on our page about LGBTQ+ fertility care at AFCC. 

How Many IVF Cycles Are Covered?

Coverage is measured in completed egg retrievals, not full IVF cycles. Each patient is covered for up to four egg retrievals. If a live birth occurs, two additional retrievals will be covered, with a lifetime maximum of six retrievals. Each completed retrieval can support multiple embryo transfers, so a single retrieval may translate to several attempts at pregnancy.

Fertility Preservation

The mandate also requires coverage for standard fertility preservation services when a medically necessary treatment may cause iatrogenic infertility (such as chemotherapy or radiation that could impair fertility). In most cases, a medical necessity applies to serious diagnoses such as cancer. If you’re facing a diagnosis that could affect your fertility, our team can help you move quickly. Learn more about our oncofertility treatments here. 

What Changed in 2026: The Castro Law Explained

The most important update for Illinois patients is the removal of the old 25-employee threshold. Before January 1, 2026, the fertility mandate only applied to employers with more than 25 employees. Many small businesses fell outside the law, leaving their employees without guaranteed coverage.

Under the Castro law, that threshold is gone. The mandate now applies to every group health policy with pregnancy-related benefits issued in Illinois, regardless of employer size. The 2026 update also:

• Explicitly lists surgical sperm extraction as a covered procedure

• Confirms coverage for preimplantation genetic testing (PGT)

• Strengthens protections for inclusive access to care

Who Is Not Covered by the Illinois Mandate?

Even with the 2026 expansion, the Illinois mandate has limits. The following situations may fall outside the state requirements:

• Self-funded (ERISA) plans: Many large employers “self-fund” their health insurance, meaning the employer, not an insurance company, pays claims directly. These plans are governed by federal ERISA law and are not required to follow state mandates. Many self-funded employers *choose* to offer fertility benefits, but they are not legally required to.

• Out-of-state policies: If your insurance is issued in another state, Illinois rules don’t automatically apply.

• Individual (non-group) policies: The mandate applies to group plans. Individual plans sold on the marketplace operate under different rules - though, as noted below, plans purchased through HealthCare.gov in Illinois generally follow the state mandate.

• Religious employers: The law does not require religious employers to cover fertility treatment.

• Medicaid: Illinois Medicaid does not cover IVF. It does cover certain medically necessary fertility preservation services (for example, prior to gonadotoxic cancer treatment) and offers separate Family Planning programs.

The Single Question to Ask HR

If you remember only one thing from this article, make it this: ask your HR or benefits team, “Is our health plan fully insured in Illinois, or is it self-funded (ERISA)?” The answer drives everything else about your fertility coverage.

How the Federal TrumpRx Program Fits In

In October 2025, the Trump administration announced a deal with EMD Serono (the maker of three of the most common IVF injectable medications) to offer steep discounts through a new federal platform, TrumpRx.gov, which launched on February 5, 2026.

Here’s what it does — and what it doesn’t do.

What TrumpRx Covers

TrumpRx applies only to specific brand-name fertility medications:

• Gonal-f® (follitropin alfa) — ovarian stimulation

• Ovidrel® (choriogonadotropin alfa) — trigger injection

• Cetrotide® (cetrorelix acetate) — prevents premature ovulation

When all three are used together in a typical IVF protocol, eligible patients can access up to an 84% discount off list prices, which can translate to savings on the medication portion of an IVF cycle.

What TrumpRx Does Not Cover

It’s important not to confuse drug discounts with insurance coverage. TrumpRx is a cash-pay discount program for specific medications, not a mandate for IVF treatment coverage. It does not cover:

• Monitoring visits, ultrasounds, or bloodwork

• The egg retrieval procedure or anesthesia

• Embryology lab services or PGT

• Embryo transfer

• Embryo, egg, or sperm storage

• Other fertility medications outside the three listed above

There are also eligibility limits. Patients enrolled in Medicare, Medicaid, TRICARE, VA, or other government drug programs are generally excluded, even if those programs don’t cover IVF. TrumpRx purchases are cash-pay only and cannot be combined with insurance or submitted for reimbursement.

The Bottom Line on the Federal Initiative

Federal action on IVF affordability is meaningful — but there is still no federal law requiring insurance to cover IVF. For now, Illinois state law remains the strongest lever for IVF coverage available to Chicago-area patients. The federal program may help reduce out-of-pocket medication costs for patients who qualify and whose protocols use the covered drugs; it doesn’t replace insurance.

Our financial team can help you think through whether to use insurance, TrumpRx, or a combination of both for the medication portion of your cycle.

Talking to Your Employer About Fertility Care Coverage

To find out exactly what your employer-provided plan covers, start with your HR benefits contact. You can also call the customer service number on the back of your insurance card. When you ask, dig beneath the surface — “Is fertility covered?” isn’t enough on its own.

If your employer offers multiple health plans, consider asking:

• Which plans, if any, provide fertility treatment coverage?

  • This question is especially useful during open enrollment if you’re considering switching.

• Is the plan fully insured in Illinois or self-funded (ERISA)?

• Are there waiting periods before fertility benefits become accessible?

• Which specific procedures are covered? Are there age limits or pre-authorization requirements?

• Is PGT covered? Is donor or gestational carrier care included?

• Are there network requirements (for example, ASRM/SART-accredited clinics)?

If your plan does include fertility coverage, take a few extra steps:

• Request a written copy of the Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC) and review the infertility/ART section carefully.

• Confirm your deductible, co-pay, and in-network providers.

• Understand the pre-authorization process for each phase of treatment.

• Re-check your benefits periodically — plans can change at renewal.

Our financial counselors at AFCC can help you make sense of your insurance plan, verify your benefits, and identify the most cost-effective path through treatment. Many patients are surprised at how much complexity a benefits review can take off their plate.

What If Your Employer Doesn’t Offer Fertility Coverage?

If your employer doesn’t currently provide fertility benefits, you have options.

Ask them to add it. The case for coverage is strong: the World Health Organization estimates that 1 in 6 adults worldwide is affected by infertility. Adding fertility benefits typically does not significantly raise group premiums, and broader coverage often reduces costs because patients can make decisions based on medical need rather than financial pressure — for example, choosing single embryo transfers when appropriate, which lowers the risk of costly multiple births. RESOLVE: The National Infertility Association offers sample letters and talking points to help employees advocate for coverage.

Look at marketplace plans. Illinois residents may be able to purchase a self-funded individual insurance policy through HealthCare.gov that includes fertility coverage following the Illinois mandate. Marketplace plans require monthly premiums and may have deductibles and coinsurance, so factor these in when comparing to out-of-pocket treatment costs.

Explore financing. AFCC partners with several fertility-specific financing companies to make treatment more accessible, including PatientFi, Future Family, and LendingClub. See all of our financing options here.

Use TrumpRx for eligible medications. If you’re paying cash for any portion of your cycle and your protocol uses Gonal-f, Ovidrel, or Cetrotide, the federal discount program may reduce medication costs substantially.

Fertility Insurance Coverage FAQs

How do I know if my plan covers fertility treatment? Start by reviewing your plan’s Summary of Benefits and Coverage (SBC) and looking for the infertility or assisted reproductive technology (ART) section. Then call the number on the back of your insurance card to confirm. AFCC’s financial team can also verify your benefits for you.

Does the 2026 Illinois law mean everyone in Illinois automatically has IVF coverage? No. The mandate applies to fully insured group plans issued in Illinois that provide pregnancy-related benefits. Self-funded (ERISA) plans, out-of-state policies, and individual plans may still operate outside the state mandate. Always confirm your plan type with HR.

How many IVF cycles are covered under Illinois law? Coverage is measured by completed egg retrievals — up to 4 retrievals, with 2 additional retrievals after a live birth, for a lifetime maximum of 6 retrievals. Each retrieval can support multiple embryo transfers.

Are single patients and LGBTQ+ patients covered? Yes. Illinois’s definition of infertility includes the inability to reproduce as a single individual or with a partner without medical intervention. Qualifying plans must extend coverage on this basis. 

Does Illinois Medicaid cover IVF? No. Illinois Medicaid does not cover IVF. It does cover certain medically necessary fertility preservation services and separate Family Planning programs.

Does TrumpRx lower the total cost of an IVF cycle? Only the medication portion, and only for three specific EMD Serono drugs (Gonal-f, Ovidrel, Cetrotide). Procedure fees, lab work, monitoring, PGT, anesthesia, storage, and other medications are not affected by the program. Insurance — not the federal program — remains the main lever for treatment costs.

Can I pay for fertility treatment out of pocket? Yes. AFCC offers transparent pricing and several financing options for patients paying out of pocket. Our financial counselors can build a treatment plan that fits your budget.

What if my plan is self-funded (ERISA)? The Illinois mandate doesn’t require self-funded plans to provide fertility coverage, but many employers offer benefits voluntarily. If yours doesn’t, this is an excellent time to advocate — fertility benefits are increasingly viewed as a key part of competitive benefits packages.

How AFCC Can Help

Insurance is one of the most complicated parts of the fertility journey, and you shouldn’t have to navigate it alone. AFCC’s financial counselors can:

• Verify your benefits — determine whether your plan is fully insured or self-funded, and confirm how it aligns with Illinois law.

• Coordinate pre-authorizations and document medical necessity when needed.

• Plan around the 2026 updates — especially helpful for patients whose employers previously fell under the 25-employee threshold.

• Identify the most cost-effective pathway — combining insurance, TrumpRx (where applicable), and financing options.

• Walk you through marketplace plan options if your employer doesn’t offer fertility benefits.

We encourage every patient to take advantage of this resource — most people leave their benefits consultation surprised at how much support is available.

Learn More About Fertility Insurance Coverage in Illinois

If you’re considering fertility care and want clarity on what your insurance will cover, our team is here to help. Visit our Fertility Insurance & Benefits page for a deeper look at how AFCC works with insurance carriers, or schedule a consultation to talk with our team directly. Whatever your starting point, you don’t have to figure this out on your own.

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