When intended parents begin the surrogacy journey, one of the first financial questions is whether insurance can help cover the high costs of in vitro fertilization (IVF) and pregnancy. Insurance for surrogacy is complex because it can involve two different people and two types of care: the surrogate’s pregnancy and the intended parents’ fertility treatments.
Some insurance plans will cover a standard pregnancy but exclude pregnancies carried by a surrogate. Others provide partial coverage for IVF but set strict requirements or lifetime limits. To make things even more complicated, laws about fertility insurance vary by state, and employer plans are not always required to follow those rules.
This guide explains what insurance typically covers in the surrogacy IVF process, how state mandates apply, which major insurance companies and employer programs provide coverage, and what intended parents should budget for. By the end, you will have a clear overview of how IVF and surrogacy insurance works and where Surrogacy by Faith can support you.
What Insurance Covers in the Surrogacy IVF Process
What insurance covers for surrogates
Most health insurance policies cover a standard pregnancy, including prenatal appointments, ultrasounds, blood tests, labor and surrogate birth, and treatment for pregnancy complications. In many cases, this also extends to the newborn’s immediate care in the hospital.
When surrogacy is involved, the same rules can apply, but only if the surrogate’s plan does not include a surrogacy exclusion. Some policies quietly include a clause denying claims when the pregnancy is carried for someone else. If that is the case, intended parent must look for supplemental insurance.
Because of these variations, the first step in any surrogacy journey is to have the surrogate’s policy professionally reviewed. If the plan is usable, intended parents usually cover her premiums, deductibles, and copays so that she never faces financial risk while carrying their child.
What insurance covers for intended parents
Intended parents are typically the ones undergoing fertility treatment, and this is where coverage becomes less predictable. Some insurance plans will pay for initial fertility testing, bloodwork, and sometimes IVF medication such as ovulation stimulants. Others extend to treatments like intrauterine insemination (IUI). IVF, however, is far less commonly included and, when it is, coverage often comes with strict conditions.
Examples include requirements for a formal infertility diagnosis, a minimum number of failed IUI attempts, or proof that the parents have been trying to conceive for a set number of months. Some plans limit coverage to a small number of IVF cycles or impose a lifetime dollar maximum. Once that limit is reached, all further IVF expenses are out of pocket.
This means intended parents must carefully separate what their own insurance will cover for IVF from what the surrogate’s policy will cover for pregnancy. Two very different benefit structures are at play in the same surrogacy arrangement.
Common exclusions to watch for
Exclusions are often hidden in the fine print but can have a major impact. The most common ones include:
- Surrogacy exclusions: A clause stating that the insurer will not pay for a pregnancy carried by someone other than the policyholder.
- Infertility treatment exclusions: IVF, egg retrieval, embryo transfer, or genetic testing may all be excluded, even if diagnostic testing is covered.
- Coordination of benefits clauses: If both the surrogate and intended parents have policies that could apply, insurers may argue over which plan is primary. This can lead to delays or denials unless clarified in advance.
Because exclusions vary so much by insurer, intended parents are strongly advised to obtain the full policy booklet and not rely only on the summary. A professional review by an insurance specialist or attorney is often worth the investment.
How intended parents typically participate
When the surrogate’s plan can be used, intended parents step in to handle all costs tied to her medical care. This usually includes paying her premiums each month, covering deductibles and copays for visits, tests, and hospital care, and making sure any bills are processed promptly. To keep the process transparent and stress-free, these funds are often managed through an escrow account.
Some intended parents also choose to purchase a supplemental surrogacy-specific policy to protect against exclusions or unexpected costs. This can be especially important in case of pregnancy complications or neonatal care, where expenses can escalate quickly. Having this safety net ensures that both the surrogate and intended parents are financially protected throughout the journey.
How IVF Is Covered in Surrogacy Arrangements
IVF costs are separate from the surrogate’s pregnancy costs
IVF is the medical process used to create embryos before they are transferred to the surrogate. Because this step involves the intended parents’ medical care, it is not billed under the surrogate’s insurance. Even when the surrogate’s policy fully covers her pregnancy and delivery, it will not extend to IVF.
This means intended parents must review their own insurance for fertility treatment benefits. IVF is usually considered a separate category of care from pregnancy and maternity coverage. In practice, families often need to coordinate two policies: the surrogate’s plan for pregnancy-related expenses and the intended parents’ plan (or personal funds) for IVF. Understanding this separation early is critical for accurate budgeting.
Insurance requirements for IVF approval
When insurance does include infertility benefits, approval for IVF almost always comes with conditions. Insurers want proof that IVF is medically necessary. Common requirements include documentation of an infertility diagnosis, medical records showing a certain period of unsuccessful attempts to conceive, or evidence of multiple failed rounds of intrauterine insemination (IUI).
Some plans also limit how many IVF cycles are covered, typically between two and four, and many place a lifetime cap on the dollar amount they will reimburse. Once the maximum is reached, further treatment must be paid out of pocket. Because IVF is expensive, these limits can be reached quickly.
Prior authorization is another frequent requirement. This means the fertility clinic must submit medical notes and a detailed treatment plan for the insurer’s approval before treatment begins. Without pre-approval, claims are often denied.
Typical documents to collect
To avoid delays or denials, intended parents should gather all necessary documents before starting IVF. These include:
- The Summary of Benefits and Coverage (SBC), which outlines infertility and maternity benefits.
- The full plan booklet or Evidence of Coverage, which spells out exclusions and limits in detail.
- Authorization or pre-certification letters from the insurer confirming approval for IVF.
- Medical policy reference numbers, such as clinical policy bulletins that define criteria for infertility treatment.
Having this documentation on hand not only helps clinics submit claims correctly but also gives intended parents peace of mind that they know exactly what is and isn’t covered.
State Fertility Insurance Laws and IVF Coverage
How state mandates affect IVF coverage
Fertility insurance coverage in the United States is largely determined at the state level. Around 20 states have laws requiring insurers to provide some form of infertility coverage, though the details vary significantly. Some states mandate coverage for diagnostic testing or basic fertility treatments, while others specifically require IVF coverage.
Even in states with strong mandates, not every policy is affected. State laws usually apply only to fully insured health plans, meaning the insurer, not the employer, assumes the financial risk. Self-insured employer plans are governed by federal law and are not required to follow state mandates. This distinction makes it crucial for intended parents to check not just where they live, but also the type of plan they have.
Fully insured vs. self-insured employer plans
A fully insured plan is purchased from an insurance company, and state law dictates which benefits must be included. If you live in a mandate state and have a fully insured plan, your policy may include IVF benefits.
A self-insured plan, on the other hand, is funded directly by the employer. Large companies often choose this route because it gives them flexibility and cost control. These plans are not bound by state mandates, which means even if you live in a mandate state, your employer may exclude IVF coverage entirely. This can come as a surprise to employees who assume state law applies to them.
State-specific IVF coverage examples
New York requires large-group insurance plans to cover up to three IVF cycles. The law also mandates coverage for fertility preservation for people undergoing medical treatments like chemotherapy. However, small-group and individual plans may have different rules.
Illinois mandates that many insurance plans cover infertility treatment, including IVF, up to six egg retrievals. Certain exemptions apply for religious organizations and small employers.
California passed SB-729, a law that will require large-group insurers to cover IVF and fertility preservation. Its implementation has been delayed, but when it takes effect, it will expand access for thousands of families in the state.
These examples show how coverage can look very different depending on location. While some states provide generous benefits, others have no mandate at all, leaving intended parents to cover IVF costs out of pocket.
What to verify before relying on a state mandate
Before assuming coverage applies, intended parents should confirm:
- The type of health plan: fully insured or self-insured. This information is often printed on the insurance ID card or available through HR.
- The effective dates of any mandates. A new law may not yet be in force, or the plan year may need to renew before changes apply.
- The medical necessity criteria used by the insurer. Even in mandate states, insurers may require documentation of infertility before approving IVF.
Careful verification prevents unexpected denials and helps intended parents know what portion of IVF will be supported by insurance versus what must be self-funded.
Which Insurance Companies Cover IVF for Surrogacy
Major national providers offering IVF coverage for surrogacy
Aetna:
Aetna plans include fertility treatment coverage and IVF can be part of the benefits. However, the scope of coverage varies widely between employer-sponsored and individual plans. Some Aetna policies only cover diagnostic testing and medications, while others extend to full IVF cycles.
But many Aetna plans exclude IVF when the embryo is intended for transfer to a surrogate. Because of this, families working with Aetna must ask very specific questions: Does the plan cover IVF up to embryo creation only? Are embryo transfers to a surrogate excluded? Are medications included, or billed separately? Written pre-authorization is often required before any treatment begins.
Cigna:
Cigna is considered one of the more comprehensive insurers when it comes to fertility benefits, particularly for employees of large companies. Cigna coverage can include diagnostic tests, IUI, and IVF, but conditions apply. Most Cigna plans require a formal infertility diagnosis and often insist on failed attempts at less invasive treatments before IVF is approved.
Some policies may cover IVF cycles only if the embryo will be transferred to the policyholder, not a surrogate. For intended parents, this distinction is critical. Talking directly with Cigna member services and obtaining policy documents is the best way to confirm what is and is not covered.
UnitedHealthcare:
UnitedHealthcare offers fertility coverage in many employer-sponsored plans, often including IVF, medications, and lab work. The company also partners with fertility benefit managers, which can make access easier. However, like Aetna and Cigna, surrogacy-related exclusions appear in many policies.
This means IVF may be covered, but only when the embryo is transferred to the insured individual. If embryos are created for transfer to a surrogate, the claim may be denied. Because UnitedHealthcare has many variations of plans, intended parents must verify cycle limits, medication coverage, and surrogacy language.
Blue Cross Blue Shield (BCBS):
BCBS is not one single company but a federation of independent insurers, which makes coverage highly state-specific. In Massachusetts, for example, BCBS plans often provide generous fertility benefits, including IVF cycles. In other states, coverage may be limited to diagnostic testing only. Some BCBS affiliates explicitly exclude surrogacy, while others leave the language vague. Families considering BCBS must check both the state mandate (if one exists) and their plan’s Evidence of Coverage. It is not uncommon for two BCBS plans in neighboring states to offer very different benefits.
Regional and state-specific insurers
Kaiser Permanente (California):
Kaiser plans in California are directly impacted by state legislation. With SB-729 expected to require IVF coverage in large-group plans, Kaiser will likely expand its fertility offerings. Currently, Kaiser may cover diagnostic testing, some medications, and IVF cycles, but surrogacy-related exclusions are possible. Because Kaiser is both an insurer and provider, its internal policies can be more restrictive. Intended parents should ask specifically whether embryo transfer to a surrogate is considered eligible.
Horizon Blue Cross (New Jersey):
Horizon is a strong example of how state mandates shape coverage. New Jersey requires insurers to cover certain fertility services, including IVF, and Horizon complies with those rules. However, just like with national providers, the surrogate-related exclusion must be reviewed. Horizon members often have broader fertility coverage than in states without mandates, but intended parents still need to clarify what happens if embryos are used in a surrogacy arrangement.
Employer-sponsored and specialized providers
Carrot Fertility:
Carrot is not a traditional insurance company but a fertility benefits platform that partners with employers. Employees whose companies use Carrot may receive funds or credits to spend on fertility-related expenses, including IVF, egg retrieval, and surrogacy coordination. Carrot’s flexibility is a major advantage, as intended parents can often apply their benefits toward embryo creation even if their primary health insurance excludes surrogacy.
Maven Clinic:
Maven Clinic provides virtual fertility and family-building benefits through employer programs. Coverage can include consultations, IVF cycles, and surrogacy support. Maven often supplements traditional insurance, filling the gaps left by exclusions. Employers that offer Maven give their workers a significant advantage, since surrogacy-related expenses are recognized in ways standard insurance may not.
WINFertility:
WINFertility works with both employers and insurers to deliver bundled fertility benefits. Packages often include IVF cycles, medications, and care coordination. Some WINFertility programs explicitly extend support to surrogacy journeys, making them valuable for intended parents. However, as with other providers, specifics depend on the employer’s chosen package.
Insurers that may not cover IVF for surrogacy
While some insurers provide partial or full coverage for IVF, others specifically exclude surrogacy arrangements. Common examples include:
- HMO plans: These plans usually have limited provider networks and are less likely to cover specialized fertility treatments. IVF is often excluded entirely, and if included, surrogacy is rarely recognized.
- Self-insured employer plans: Since these plans are governed by federal law, employers can decide whether to include fertility benefits. Many choose not to cover IVF or specifically exclude surrogacy. This means even employees in mandate states can be left without coverage.
- High-deductible health plans (HDHPs): These plans may technically cover IVF but require members to pay large deductibles before benefits begin. This can leave intended parents paying tens of thousands of dollars upfront, even with coverage.
Because of these risks, intended parents are strongly encouraged to request written confirmation of benefits. Asking the insurer directly, “Does this plan cover IVF when the embryos will be used in a surrogacy arrangement?” helps avoid unexpected denials.
Insurance Costs and Budgeting
How much is IVF with insurance
The average cost of a single IVF cycle in the United States is between $15,000 and $20,000, and medications can add another $5,000 to $7,000. With insurance, these numbers can be reduced, but the exact savings depend on the scope of coverage. Some policies cover diagnostic testing and medications but not the actual IVF procedure. Others cover a limited number of IVF cycles but exclude embryo transfer to a surrogate.
Even with good coverage, families may still face significant costs. For example, a policy that covers 50% of IVF expenses could still leave intended parents responsible for $8,000 to $10,000 per cycle. If the plan requires pre-authorization or limits coverage to two or three cycles, expenses can quickly exceed the benefit maximum.
Common out-of-pocket items to plan for
Even when insurance is in place, surrogacy almost always involves additional expenses. Intended parents should be prepared for:
- Deductibles and coinsurance: These must be met before insurance begins paying, and they reset annually.
- Fertility medications: Some plans exclude them, and they can cost several thousand dollars per cycle.
- Lab work and genetic testing: Pre-implantation genetic testing (PGT) and other specialized tests may not be included.
- Cryopreservation and storage fees: Embryo freezing and storage are often considered elective and excluded from coverage.
- Surrogacy-specific exclusions: Even if IVF is covered, the embryo transfer to the surrogate may be denied.
Budgeting for these items is essential, since they can add up quickly and catch families by surprise.
Steps that reduce denials and surprise bills
Careful preparation can make a big difference in avoiding unexpected costs. Intended parents can take the following steps:
- Verify coverage in writing: Always request a written statement from the insurer about IVF benefits and surrogacy exclusions.
- Get pre-authorization early: Have the fertility clinic submit medical records and treatment plans before any procedures begin.
- Confirm network status: Make sure the fertility clinic, lab, pharmacy, and hospital are all in-network. Out-of-network bills are one of the most common causes of surprise expenses.
- Track benefit usage: Keep records of how many cycles have been billed, what the lifetime maximum is, and how much has been used.
- Consider supplemental insurance or benefit programs: Platforms like Carrot, Maven, or WINFertility can help cover gaps left by traditional insurance.
By taking these steps, intended parents can minimize unexpected financial strain and plan realistically for both IVF and the surrogate’s pregnancy costs.
Frequently Asked Questions About IVF and Surrogacy Coverage
Can I purchase infertility insurance?
There is no separate infertility insurance policy available for individuals to buy. Fertility coverage is almost always tied to employer-sponsored health insurance or state laws that mandate coverage.
Some employers enhance their benefits by partnering with fertility benefit platforms such as Carrot Fertility, Maven Clinic, or WINFertility. These programs provide funds or credits that employees can use for fertility treatments, often including IVF, egg retrieval, and sometimes surrogacy-related costs. Because these benefits are employer-funded, the scope is usually broader and more flexible than traditional insurance.
For those without employer coverage, options include financing programs offered by fertility clinics, shared-risk or multi-cycle packages, or savings accounts specifically set up for fertility expenses. While these are not “insurance” in the strict sense, they provide structured ways to manage the financial burden of IVF.
Does Blue Cross Blue Shield cover IVF?
Blue Cross Blue Shield operates as a federation of independent companies across the U.S., so coverage depends on the state and the specific plan. In states with fertility mandates, such as Massachusetts, New Jersey, or Illinois, many BCBS plans include robust IVF coverage. This may extend to multiple cycles, medications, and even fertility preservation.
In other states, BCBS coverage may be far more limited, sometimes only including diagnostic testing or excluding IVF entirely. Even when IVF is covered, many BCBS plans draw the line at surrogacy. This means IVF to create embryos may be reimbursed, but the transfer of those embryos to a surrogate could be denied.
Because the differences are so large, intended parents with BCBS should contact their local affiliate directly, ask for the Evidence of Coverage document, and confirm in writing whether IVF related to surrogacy is included.
Does Aetna cover IVF?
Aetna is one of the larger insurers offering fertility benefits, but coverage depends heavily on the employer and plan design. Many Aetna plans cover diagnostic testing, IUI, and IVF when medical criteria for infertility are met. Common requirements include documentation of infertility, prior unsuccessful treatments, and pre-authorization from the insurer before starting IVF.
However, surrogacy is a common exclusion. This means Aetna may cover IVF up to the stage of embryo creation but deny claims if the embryos will be transferred to a surrogate. Intended parents should ask their fertility clinic and Aetna representative to confirm whether surrogacy is recognized under their plan.
Cycle limits are another important factor. Some Aetna plans cover only two or three IVF cycles, while others cap benefits at a lifetime dollar amount. Understanding these limits in advance helps families plan for possible additional out-of-pocket expenses.
Does Medicaid cover IVF?
Medicaid, the public health insurance program for low-income individuals, does not generally cover IVF or other advanced fertility treatments. The program is designed to provide essential medical services, and infertility is not considered an essential benefit.
A few exceptions exist at the state level. For example, New York’s Medicaid program covers some fertility-related medications but does not cover IVF procedures. No state Medicaid program currently pays for IVF itself, and surrogacy-related services are excluded everywhere.
For intended parents relying on Medicaid, this means IVF costs will almost certainly need to be paid out of pocket. Some may be able to access employer-sponsored fertility benefit programs if they are working, but for most families, financing options and clinic-based payment plans become the only alternatives.
Insurance Checklist for Intended Parents
Verify your plan type and infertility benefits
The first step is to confirm whether your insurance plan is fully insured or self-insured. This distinction determines whether state fertility mandates apply. Fully insured plans must comply with state laws, while self-insured employer plans are regulated by federal law and can exclude IVF or surrogacy altogether. You can usually find this information on your insurance card or through your HR department. Once confirmed, review the full plan booklet (also called Evidence of Coverage), not just the summary. Look for sections on “infertility,” “assisted reproductive technology,” and “maternity” to see what is included.
H3. Get preauthorization early
Most insurers require prior approval before covering IVF. This process involves your fertility clinic submitting medical records, test results, and a treatment plan to the insurer. Without written authorization, claims are often denied, even if the treatment would normally be covered. Start this step early, because insurers may request additional documents or impose waiting periods. Keep copies of authorization letters for your records and share them with your clinic to avoid delays.
Confirm network status for every step
Fertility treatment involves more than just the clinic. Labs, pharmacies, anesthesiologists, and hospitals all play a role, and each one must be in-network to maximize benefits. An IVF cycle billed out-of-network can cost thousands more, even with insurance. Ask your clinic to confirm the network status of every provider involved in your treatment, and call your insurer directly if you are unsure. This is especially important for specialty fertility pharmacies, which may not always participate in standard pharmacy networks.
Coordinate benefits with the surrogate’s insurance plan
If your surrogate’s health insurance can be used, you will be responsible for paying her premiums, deductibles, and copays during the pregnancy. These payments are usually managed through an escrow account, which ensures that bills are paid on time and fairly. If the surrogate’s plan excludes surrogacy, you may need to purchase a supplemental policy. These surrogacy-specific policies can cover complications, extended hospital stays, or neonatal care that might otherwise create overwhelming costs. Having this protection in place ensures that neither the surrogate nor the intended parents face unexpected financial stress.
Keep records and track benefit usage
IVF and surrogacy involve multiple cycles, procedures, and bills, and it is easy to lose track. Keep organized records of everything: preauthorization letters, explanation of benefits (EOBs), payment receipts, and notes from calls with insurers. Track how many cycles have been used and how much of the lifetime maximum has been applied. This prevents surprises, such as discovering too late that your benefit limit has been exhausted. Some intended parents even create a spreadsheet to log claims and payments for clarity.
Consult experts when needed
Insurance for IVF and surrogacy is one of the most complex areas of health coverage. Exclusions are often hidden in technical language, and misinterpretations can lead to expensive denials. Many families choose to work with insurance specialists, attorneys, or surrogacy agencies that can review policies and negotiate with insurers. While this adds a small cost upfront, it can save tens of thousands of dollars later by preventing uncovered bills. Expert guidance also provides peace of mind, freeing you to focus on your family-building journey instead of fighting with insurance companies.
Why Start Your Surrogacy Journey With Surrogacy By Faith
At Surrogacy by Faith, we know that surrogacy insurance questions are often the most stressful part of planning a surrogacy journey. Intended parents want clarity and security, but insurance policies are filled with exclusions, state-specific rules, and technical language that make it difficult to know what will actually be covered. Our role is to simplify this process and protect you from unexpected surprises.
Our team begins by carefully reviewing both the surrogate’s health insurance and the intended parents’ fertility coverage. If a surrogate’s plan excludes surrogacy, we help identify supplemental options so her pregnancy is fully protected. For intended parents, we guide you through understanding IVF benefits, cycle limits, and what to expect financially. Our team also coordinates directly with clinics, insurers, and escrow providers to ensure every bill is handled transparently and fairly.
Choosing Surrogacy by Faith means choosing a partner who not only understands the medical and legal aspects of surrogacy but also values compassion and trust. We are committed to helping you build your family with peace of mind, knowing your insurance and finances are being handled with the same care as the rest of your journey.
For intended parents considering surrogacy, the best way to start the journey is by exploring the intended parent application process. Women interested in becoming surrogates can learn more about the steps involved by reviewing the surrogate mother application process.