Is egg freezing in Illinois covered by insurance?

• Cancer/Medical Treatments: Insurance must cover egg freezing if a necessary medical treatment (like chemotherapy or radiation) could cause infertility.
• Expanded Definition of Infertility: As of Jan 1, 2022, Illinois law covers those unable to conceive naturally, including same-sex couples, single people, and women over 35 trying for six months, potentially triggering coverage for preservation. 

• Elective Freezing: If you're freezing eggs solely to delay childbearing without a specific medical trigger, it's often considered elective and not covered by the state mandate.
• Employer Exemptions: Self-insured employers (often large companies) and those with fewer than 25 employees are exempt from the mandate. 

Bottom line: Illinois already has one of the strongest fertility-coverage mandates in the country, and it gets even stronger on January 1, 2026 (thanks to Sen. Cristina Castro’s law). The White House’s new deal to cut prices on certain IVF medications may help some patients with drug costs in early 2026, but it does not mandate insurance coverage for IVF, fertility care, or medications.

Cheaper IVF Meds (maybe) in 2026?

On October 16, 2025, the White House announced a public-private deal with EMD Serono (maker of Gonal-F, Ovidrel, Cetrotide) to offer large discounts via a new TrumpRx.gov portal, projected to save patients up to ~$2,200 per IVF cycle on medications. The portal is slated to launch in early 2026. This is about drug pricing, not full treatment coverage, and participation/eligibility details still matter.

Here’s the catch — there’s still no federal rule requiring IVF coverage. Employers can choose to add fertility benefits, but it’s completely optional. Additionally, pharmaceutical companies (like EMD Serono) may already offer discounts on medications for self-pay patients.

What Illinois Law Covers Today (through Dec 31, 2025)

Illinois requires many (but not all) employer group plans (fully insured, with >25 employees and pregnancy benefits) to cover the diagnosis and treatment of infertility, including IVF, IUI, embryo transfer, etc. Coverage is subject to clinical criteria and administrative rules (e.g., limits tied to egg retrieval counts).

What These Rules Actually Mean for You As a Patient:

• Who qualifies as “infertile”?
  Illinois law defines infertility as failure to establish or carry to live birth after 12 months of trying if ≤35, or after 6 months if >35; it also covers inability to reproduce without medical intervention (e.g., single patients, LGBTQ+ pathways) or based on a physician’s findings.
• Where care must occur: Procedures must be performed at clinics meeting ASRM/SART/ACOG standards. (Yes—this matters to claims.)
• Cycle/egg-retrieval limits (high-level): Illinois rules tie coverage for IVF-level care to reasonable, less costly steps first unless medically inappropriate, and cap covered oocyte retrievals (generally up to four, with up to two additional after a live birth—lifetime max six). Always check your plan’s fine print against the state minimums.
• What’s not bound by the state mandate: Self-insured (ERISA) employer plans (very common at big companies) aren’t required to follow state mandates. Ask HR if your plan is fully insured or self-funded. Additionally, other institutions may be excluded from the mandate – it is important to always check your specific fertility coverage.

What Changes in Illinois on January 1, 2026 (“Castro law”)

Starting Jan 1, 2026, Illinois expands the mandate to every group health insurance policy that provides pregnancy-related benefits—i.e., removing the old “>25 employees” threshold. The statute also explicitly lists covered procedures (and adds surgical sperm extraction to the enumerated list). In short: more small-group plans will be required to cover infertility diagnosis and treatment, including IVF.

What This Means if You Live in Illinois

• If your employer plan is fully insured and issued in Illinois:
  You likely have infertility benefits now (2025) if your employer has >25 employees; in 2026, the mandate broadens to cover all group plans with pregnancy benefits—use open enrollment wisely.
• If your employer is self-funded (ERISA):
  The Illinois mandate may not apply. However, your employer can choose to cover fertility/IVF—and many do. Use this moment (and 2026 drug discounts) to push for richer benefits.
• If you’re on Illinois Medicaid:
  Illinois Medicaid does not cover IVF. It does cover certain fertility preservation services when medically necessary (e.g., prior to gonadotoxic therapy) and offers separate Family Planning programs (contraception, STI services, etc.).
• Medication pricing relief in 2026:
  If you’re cash-pay or facing high drug co-pays, the EMD Serono discount via TrumpRx.gov could reduce out-of-pocket med costs—but the rest of the IVF cycle (monitoring, retrieval, lab, transfer, storage) is not covered by that deal. Always check with your Providers office or the pharmaceutical companies to see if any direct discounts are offered to self-pay patients.

Practical Next Steps (Save this Checklist)

1. Ask HR one specific question: “Is our plan fully insured in Illinois or self-funded (ERISA)?” Your benefits differ drastically based on that answer.
2. Review your plan’s 2025 Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC). Look for the Infertility/ART section and check details such as retrieval limits, PGT coverage, donor or surrogacy language, and any network requirements (like ASRM/SART-accredited clinics).
3. For 2026 open enrollment: If you’re in a small group that previously lacked coverage because of the “>25 employees” cutoff, revisit your options—Illinois’ expanded mandate should apply to all group plans with pregnancy benefits starting 1/1/2026.
4. Budget meds vs. procedures separately: Watch TrumpRx.gov launch timing and eligibility in early 2026; price out EMD Serono bundle discounts vs. your plan’s drug tiering/mailing pharmacy. Check with your Provider or the pharmaceutical company to see if there are any direct discounts available.
5. If you’re on or eligible for Medicaid: Ask about fertility preservation coverage pathways and Family Planning benefits; IVF remains excluded.

FAQs 

Q: Does the 2026 Illinois law mean everyone in Illinois gets IVF covered?
A: No. It applies to group policies with pregnancy benefits issued in Illinois. Self-funded (ERISA) plans can still opt out. Individual policies and out-of-state plans aren’t subject to Illinois’ mandate.

Q: How many IVF cycles are covered?
A: Illinois rules center coverage on oocyte retrieval counts (generally up to 4, with up to 2 more after a live birth—lifetime 6). Plans must meet or exceed state minimums; verify your plan’s exact wording.

Q: What about single patients and LGBTQ+ patients?
A: The infertility definition includes inability to reproduce “as a single individual or with a partner without medical intervention,” which supports inclusive access under qualifying plans.

Q: Will the White House announcement lower my total IVF cost?
A: It targets medications only. Procedure, anesthesia, embryology lab fees, PGT, storage, etc., are separate. Insurance—not the federal announcement—remains the main lever for those costs.

Need Help?

Our team is here to help you navigate your fertility coverage with confidence.

We can:

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