Fertility

Does North Dakota Require Insurance to Cover IVF?

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North Dakota sits with the roughly two-thirds of states that have no infertility insurance mandate, but its path to ever getting one is unusually specific: state law requires any new mandate to start with public retirees. Two 2025 bills tried to use that path and both failed on the floor.

Last updated: July 2026

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Does North Dakota Require Insurance to Cover IVF?

No. North Dakota has never passed a law requiring health insurers to cover the diagnosis or treatment of infertility, including IVF, and has neither a mandate-to-cover law nor a lighter mandate-to-offer law that would simply require insurers to make a fertility rider available for purchase. In North Dakota, whether IVF is covered is decided entirely by the employer or the individual policy, not by state law.

North Dakota sits with the roughly two-thirds of states that have no comprehensive infertility insurance mandate at all, and unlike some of those states, it hasn't come especially close to changing that recently 1. Nothing in state law prevents an individual insurer or self-funded employer from covering IVF voluntarily; it simply means nothing requires any of them to.

North Dakota's Legislative Quirk: Retirees First

North Dakota law contains an unusual structural requirement: any new fertility-coverage mandate must apply first to the state's Public Employees Retirement System (PERS) before the legislature can extend it to the general insurance market. Bills in the 2025 legislative session tried to work within that rule, proposing a pilot fertility-coverage benefit for the more than 60,000 people covered through PERS, with an eye toward extending coverage more broadly only if lawmakers judged the pilot successful after a multi-year trial period.

Both of the 2025 bills were voted down. Opponents raised the same objection raised in most states debating a fertility mandate: covering more services broadly raises premiums for everyone who pays them, a concern legislators weighed against the cost fertility patients face without any coverage floor at all. Until a future session revisits the issue, North Dakota's retiree-first requirement means the state's own employees would likely see any future benefit before private-sector workers would, and private-sector coverage would depend on a second round of legislation even after a retiree pilot succeeded.

Why Self-Funded Employer Plans Would Sit Outside Any Future North Dakota Mandate

Even a future North Dakota mandate, if one eventually passes, would not reach self-funded employer health plans, which fall under federal ERISA law rather than state insurance law, the same limit every other state's mandate runs into 1. A national employer with a North Dakota location often self-funds precisely so the same benefit rules apply company-wide, rather than adjusting per state.

That means the practical question for a North Dakota resident today is the same one it would likely be even after any future mandate: is this specific plan fully insured or self-funded, and that answer usually has to come from a benefits administrator directly, not from the name on an insurance card. Two North Dakota residents at different employers in the same city can end up with entirely different answers to that question, even if both plans are administered by the same insurance carrier.

What IVF Costs Without Any North Dakota Coverage Floor

With no mandate and no pilot program in effect for anyone outside a potential future PERS pilot, North Dakota families weighing IVF should expect to plan around paying most or all of the cost themselves. A prospective cohort study following infertility patients' real spending for eighteen months found that out-of-pocket costs climb steeply once care reaches IVF, with the heaviest costs concentrated among the smaller share of patients who get that far rather than stopping at less invasive treatment 2.

Nationally, IVF use is large enough to matter at scale: an estimated 238,000 patients underwent roughly 414,000 assisted reproductive technology cycles in the most recent year with full federal reporting 3. A missing state mandate doesn't mean fertility care is rare in North Dakota; it means the cost of that care currently falls almost entirely on the patient.

North Dakota's Distance Problem Compounds the Coverage Gap

North Dakota is among the least densely populated states in the country, and fertility care, which depends on frequent monitoring visits timed tightly to a single menstrual cycle, travels especially poorly across its long rural distances. Reproductive endocrinology care in North Dakota is concentrated in its largest cities, and residents across much of the western Bakken region and the state's smaller eastern communities can face a multi-hour drive to reach a specialist, entirely separate from the question of who pays.

That combination, no coverage mandate and long travel distances to care, means a meaningful share of North Dakota patients pursuing IVF do so partly out of state, adding travel costs and missed work on top of treatment costs the state doesn't require anyone to help cover. A single IVF cycle's repeated monitoring visits, compressed into a few weeks, turn a multi-hour one-way drive into a recurring cost of its own, separate from anything billed by a clinic.

How to Find Out What Your North Dakota Plan Covers

The only way to know what a specific North Dakota plan covers is to read it directly, since state law provides no floor to assume from. Start with the plan's Summary of Benefits and Coverage, and search it for "infertility," "assisted reproductive technology," or "ART" rather than just "IVF," since some plans that exclude the procedure by name still cover diagnostic testing billed under general reproductive or endocrine codes.

The North Dakota Insurance Department, led by the state's elected Insurance Commissioner, regulates insurers selling coverage in the state and is the right place to raise a compliance question about a fully insured North Dakota policy. It's also worth knowing the clinical starting point most plans and clinicians use: the field's main professional society defines evaluation as appropriate after twelve months of trying to conceive for women under 35, or six months for women 35 and older 4, with male-factor infertility evaluated on a similar timeline and treated through options ranging from medical and surgical therapy to IUI, IVF, or IVF with ICSI depending on what's found 5. Readers comparing ivf coverage in south dakota, ivf coverage in connecticut, ivf coverage in delaware, ivf coverage in florida, ivf coverage in georgia, or ivf coverage in north carolina will find requirements that look nothing alike, even though all of them sit under the same federal ERISA framework North Dakota does.

Common questions

North Dakota law requires that any new fertility-coverage mandate apply first to the state's Public Employees Retirement System before it can extend to the general insurance market. 2025 bills tried to create a retiree pilot program under that rule; both failed, which is part of why North Dakota still has no general IVF mandate.

North Dakota's Medicaid program follows the pattern seen in nearly every state Medicaid program: it is not structured to cover elective assisted reproductive procedures like IVF. Coverage rules can change, so confirming current benefits directly with the plan is more reliable than assuming based on general patterns.

It's possible. Lawmakers have introduced fertility-coverage bills more than once, most recently in 2025, though none have passed. Any future attempt would likely need to start with a pilot program for state retirees under North Dakota's existing legislative requirement before it could reach private-sector plans.

It depends entirely on the plan, since North Dakota has no mandate covering either. Some plans that exclude IVF by name still cover diagnostic bloodwork, ultrasounds, or a semen analysis under general medical benefits rather than a fertility-specific exclusion, so checking the specific billing codes is worth doing.

No. Coverage follows how and where the plan itself is issued and funded, not the employee's home address. A self-funded plan runs under federal ERISA rules regardless of the employer's headquarters, which is why reading the plan document matters more than where you live.

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Before Assuming What Your North Dakota Plan Covers

  • —assuming a plan covers IVF because a past employer's plan did, without rereading the current Summary of Benefits and Coverage
  • —assuming diagnostic testing and the IVF procedure are covered or excluded together, when many plans treat them differently
  • —starting IVF medications or procedures before getting a written coverage determination for this specific plan year

This article explains how North Dakota insurance law currently works and does not constitute insurance, legal, or medical advice. Confirm current benefits directly with the plan administrator before making treatment decisions based on assumed coverage.

References

  1. 1.RESOLVE: The National Infertility Association (2024). RESOLVE: The National Infertility Association — Insurance Coverage and Support Resources. RESOLVE: The National Infertility Association. linkGeneral existence and variability of state infertility-insurance mandates, including that North Dakota is among the states without one and that self-funded ERISA plans are commonly exempt where a mandate does exist.
  2. 2.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 real-world out-of-pocket infertility spending rises steeply as care escalates toward IVF, based on a prospective multi-site patient cohort rather than clinic-published price lists.
  3. 3.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 context on how many patients and clinics are involved in ART cycles, used to frame IVF as a well-tracked but unevenly covered category of care nationally.
  4. 4.Practice Committee of ASRM (2023). Definition of infertility: a committee opinion. American Society for Reproductive Medicine (Fertility and Sterility). linkThe clinical definition of infertility and the recommended timing to begin evaluation, 12 months under age 35 and 6 months at 35 or older, used to explain why diagnostic testing can be medically indicated independent of any insurance mandate.
  5. 5.American Urological Association / American Society for Reproductive Medicine (2020). Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. AUA/ASRM (Fertility and Sterility; Journal of Urology). linkThat male-factor infertility evaluation and treatment, including surgical and medical therapy and the role of IUI, IVF, and ICSI, is a distinct, often underrecognized part of a fertility workup that a plan's coverage exclusions may treat differently than the female-side IVF procedure.

5 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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