Fertility

Does Colorado Require Insurance to Cover IVF?

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Colorado passed one of the country's more generous fertility mandates in 2020, but it didn't arrive on schedule or for everyone: a federal rule about who pays for expanded benefits kept it from reaching individual and small-group plans, even as large-group coverage became real in 2023.

Last updated: July 2026

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Does Colorado law require IVF coverage?

Yes, for most large employers — Colorado's Building Families Act, signed in 2020 and in effect since January 2023, requires many state-regulated health plans to cover the diagnosis and treatment of infertility, including at least three completed egg retrievals and unlimited embryo transfers. Nationally, IVF is common enough that federal surveillance tracked roughly 238,000 patients across 453 reporting clinics in a single recent year 1; Colorado is one of the more generous states in requiring coverage of that care.

The qualifier 'most large employers' matters — the law's reach turned out narrower in practice than its text first promised, for reasons explained below.

What the Building Families Act actually requires

Where it applies, Colorado's mandate is one of the more comprehensive in the country: covered health plans must pay for diagnosis and treatment of infertility, including a minimum of three completed oocyte retrievals with unlimited embryo transfers from those retrievals, and separately, coverage for fertility preservation — egg or sperm freezing — for a person facing a medical treatment likely to cause infertility, such as chemotherapy.

Three completed retrievals with unlimited transfers is a materially larger benefit than a single-cycle mandate, since a patient whose first retrieval doesn't lead to a birth isn't left starting over on their own dime. The law also bars insurers from imposing exclusions or limitations on fertility treatment that they don't impose on comparable medical conditions, a provision meant to stop plans from covering infertility on paper while quietly making it harder to use than other benefits.

Why individual and small-group Coloradans are still waiting

The Building Families Act was written to cover individual and small-group plans too, and was originally set to take effect for everyone on January 1, 2022. It didn't. Federal ACA rules can require a state to personally 'defray,' or pay for, the cost of a benefit added to certain plans if that benefit goes beyond a federal baseline, and Colorado never received the federal determination it needed to add this requirement to the individual and small-group markets without triggering that obligation.

A 2022 clarifying bill let the law take effect only for the fully insured large-group market — employers with more than 100 employees — starting January 1, 2023. Individual and small-group Coloradans remain on the state's older rules, with no fixed timeline for when, or whether, that federal question gets resolved. In Colorado, a comprehensive-sounding law can still leave someone uncovered for a purely technical, federal reason, not because the state changed its mind.

Which Colorado plans are exempt from the mandate anyway

On top of the individual and small-group gap, employers that self-fund their health plan — meaning the employer, not an insurance company, actually pays claims — are governed by the federal ERISA law, which preempts Colorado's mandate entirely, regardless of employer size.

That means even some large employers fall outside the Building Families Act if their plan is self-funded rather than fully insured. RESOLVE, the national patient-advocacy group that tracks these laws state by state, is a useful place to check both a plan's funding type and whether Colorado's mandate actually reaches it 2. None of this touches Medicaid or the Children's Health Insurance Program, a separate federal-state program for lower-income children's coverage that has never included infertility treatment 3.

How Colorado's answer compares across state lines

The honest answer to this question does not travel across state lines. A patient who had a comprehensive fertility benefit while living in Colorado's large-group market should not assume the same holds in another state, and someone moving to Colorado from a non-mandate state may be surprised by how much this law actually covers, if their new employer qualifies.

ivf coverage in texas and ivf coverage in utah are each governed by that state's own law, not Colorado's; ivf coverage in pennsylvania, ivf coverage in tennessee, ivf coverage in vermont, and ivf coverage in west virginia are separate questions again, each with an answer specific to that jurisdiction. does health insurance cover ivf is ultimately a plan-by-plan question layered under a state-by-state one, and in Colorado right now, the plan's market segment and funding type matter as much as the state law itself.

Paying out of pocket in Colorado: what the individual and small-group gap costs

Anyone in Colorado's individual or small-group market, or on a self-funded plan, is still facing largely the same out-of-pocket reality patients face in states with no mandate at all. A prospective, multi-site cohort study that tracked real patient spending over eighteen months found that out-of-pocket costs for infertility care are substantial and climb steeply once treatment escalates to IVF, compared with lower-intensity options like monitored cycles or insemination 4.

That gap is worth confirming early, not after treatment starts, since the difference between 'covered' and 'not yet covered' in Colorado often comes down to a single detail: whether an employer's plan is large-group and fully insured, or something else. Financing options — payment plans, multi-cycle packages, medical credit, health savings accounts — remain worth exploring for anyone who falls outside the mandate.

Who counts as "infertile" for coverage purposes

Even where Colorado's mandate applies, coverage still depends on a clinical diagnosis of infertility, not simply a wish to conceive. The American Society for Reproductive Medicine defines infertility as a disease marked by failure to achieve pregnancy after twelve months of regular, unprotected intercourse for women under 35, or six months for women 35 and older, and the current definition explicitly includes people who need a partner's or donor's gametes to conceive 5.

Colorado's law is written broadly enough to track this modern definition rather than an older, narrower one, which is part of why it reaches more patients than some other states' mandates — but a diagnosis from a physician, not simply the patient's own account, is still what triggers coverage under the statute.

Coverage, cost pressure, and the embryo-transfer decision

Whether a patient has coverage can quietly shape a purely clinical decision: how many embryos to transfer in a single cycle. Multiple gestation is the single largest avoidable risk of fertility treatment, raising the odds of preterm birth, low birth weight, preeclampsia, and gestational diabetes, which is why professional guidance favors transferring one embryo at a time when the prognosis allows it 6.

Choosing a single embryo is not choosing lower odds over a full course of treatment, and Colorado's unlimited-transfer benefit, where it applies, removes much of the financial argument for doing otherwise — a patient with three retrievals' worth of embryos banked has room to try again. A self-pay patient outside the mandate, facing the full cost of a fresh cycle, can still feel pressure to transfer more than one embryo to raise the odds on money already spent — a documented consequence of the coverage gap, not a personal failure of judgment.

Common questions

Yes, for large-group health plans covering more than 100 employees. Colorado's Building Families Act requires those plans to cover infertility diagnosis and treatment, including at least three completed egg retrievals with unlimited embryo transfers, and it has been in effect for the large-group market since January 2023.

Not yet. The law was written to eventually cover individual and small-group plans too, but a federal ACA rule about who pays for expanded benefits has kept that part from taking effect, with no confirmed timeline for resolution. Coloradans on those plans remain under the state's older infertility rules for now.

Yes. The Building Families Act separately requires covered health plans to pay for fertility preservation, such as egg or sperm freezing, for a patient facing a medical treatment likely to cause infertility, independent of the law's broader infertility-diagnosis-and-treatment requirement. The same large-group and self-funded limits described above still apply to this benefit as well.

Not necessarily. Employers that self-fund their health plan, meaning the employer rather than an insurer pays claims directly, are governed by federal ERISA law, which preempts Colorado's mandate regardless of employer size. Checking with a benefits administrator or the plan's summary plan description confirms whether a specific large employer's plan is actually subject to the state law.

No. Health First Colorado, the state's Medicaid program, does not cover IVF; the Building Families Act applies to commercial health plans, not Medicaid. The Children's Health Insurance Program is a separate program for children in lower-income families and has never included fertility treatment.

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What to check before counting on Colorado's mandate

  • —A plan that turns out to be individual-market or small-group, where the Building Families Act's IVF requirement doesn't yet apply
  • —A self-funded or 'ASO-administered' large-employer plan, which federal ERISA law exempts from Colorado's mandate regardless of employee count
  • —A denial for fertility-preservation coverage ahead of a treatment like chemotherapy — this is time-sensitive care worth escalating immediately given the law's separate preservation requirement

This article explains how Colorado law treats fertility-treatment insurance; it is not legal or financial advice and does not review any individual policy. Check a specific plan's certificate of coverage or summary plan description, or talk with a benefits administrator or licensed insurance broker, before making treatment decisions based on assumed coverage.

References

  1. 1.Centers for Disease Control and Prevention (2023). 2021 Assisted Reproductive Technology: Fertility Clinic and National Summary Report. CDC / US Department of Health and Human Services. linkNational scale of ART use: roughly 238,126 patients underwent 413,776 ART cycles at 453 reporting clinics in 2021, the year's noncumulative national total.
  2. 2.RESOLVE: The National Infertility Association (2024). RESOLVE: The National Infertility Association — Insurance Coverage and Support Resources. RESOLVE: The National Infertility Association. linkThat state fertility-coverage mandates vary widely, that self-funded/ERISA plans commonly fall outside state mandates, and where patients can find current state-by-state coverage guidance.
  3. 3.Centers for Medicare & Medicaid Services / Medicaid.gov (2024). Children's Health Insurance Program (CHIP). Medicaid.gov (CMS). linkThat CHIP is a joint federal-state program for children in families with incomes too high for Medicaid but too low for private coverage, distinct from Medicaid and from any state infertility mandate.
  4. 4.Katz P, Showstack J, Smith JF, et al. (2011). Costs of infertility treatment: results from an 18-month prospective cohort study. Fertility and Sterility. doi:10.1016/j.fertnstert.2010.11.026 ✓That patient out-of-pocket infertility-treatment expenditures are substantial and rise steeply as treatment escalates toward IVF, based on prospective real-world spending data.
  5. 5.Practice Committee of ASRM (2023). Definition of infertility: a committee opinion. American Society for Reproductive Medicine (Fertility and Sterility). linkThe clinical definition of infertility, including the 12-months-under-35/6-months-35-or-older evaluation threshold and inclusion of those needing donor gametes to conceive.
  6. 6.Practice Committee of ASRM and SART (2022). Multiple gestation associated with infertility therapy: a committee opinion. American Society for Reproductive Medicine (Fertility and Sterility). linkThat multiple gestation is the principal avoidable risk of infertility therapy, carries elevated maternal/neonatal risk, and that single-embryo transfer is preferred where prognosis allows.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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