President Donald Trump announced a new proposed rule Monday that would allow employers to provide standalone health insurance coverage for fertility benefits.
WATCH: Trump announces new rule establishing an optional fertility benefit for workers
The rule would create a supplemental insurance option employers could offer, similar to vision or dental insurance, for in vitro fertilization services and other fertility treatments. Currently, most health insurance plans don’t cover IVF or related benefits.
“This will hopefully reduce the number of couples who ultimately need to resort to IVF because challenges can be identified and addressed very early in the process,” Trump said during an Oval Office event.
The rule, jointly announced by the Departments of Labor, Health and Human Services, and Treasury, follows a February executive order calling for policy recommendations to reduce the cost of IVF treatment. Trump promised to pay or mandate insurance coverage for IVF treatment during his 2024 campaign.
The proposed rule doesn’t go as far, though it aims to drive down costs of fertility treatments, which can cost tens of thousands of dollars.
Health Secretary Robert F. Kennedy Jr. said at the event that the U.S. is facing a “fertility crisis,” which represents “a threat not only to our economy, to our national security.”
U.S. birth rates have generally been falling for years.
Once the proposed rule is published in the Federal Register, the public will have 60 days to comment before it is finalized. It will likely be months before patients can access these benefits, said Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine.
What would the proposed rule cover?
The supplemental insurance would cover care related to diagnosing, mitigating or treating infertility. This includes lab tests, medications, genetic testing and IVF. The rule mentions treatment for conditions that may affect fertility, such as polycystic ovary syndrome and endometriosis.
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Care covered under the rule would have a lifetime cap of $120,000 for the participant and their beneficiaries. That total lifetime benefit would also be adjusted for inflation for plans starting in 2028.
“That’s enough to offer some real treatment,” Tipton said.
On average, a single cycle of IVF costs between $15,000 to $20,000, according to the Department of Health and Human Services. Patients may need multiple rounds of IVF before getting pregnant.
In February, the Trump administration launched TrumpRX, a website intended to provide Americans with discounted prescription drugs. The initiative offers select IVF medicines at a reduced price, Tipton said.
WATCH: How effective will TrumpRX be at lowering prescription drug prices for Americans?
How would fertility-related supplemental insurance work?
Under the proposed rule, employers would not be required to offer supplemental insurance.
Tipton said it’s unclear what incentives employers would have to offer this benefit.
Currently, about a quarter of large companies voluntarily cover IVF for employees, according to KFF. And at least a dozen states have mandates requiring private insurance coverage for fertility care. What care is covered varies by state.
The proposed rule’s fertility care would fall under what’s known as a limited excepted benefit. That’s a term for coverage that people can purchase through employers that are not connected to their major medical insurance.
These plans also don’t have to follow certain restrictions that general health care plans are required to by law.
The administration is “arguing that that should allow companies to offer plans more nimbly and potentially cheaper, by essentially having to sidestep many of the requirements that the U.S. has on health plans,” said Wesley Yin, public policy professor at University of California, Los Angeles.
The lack of regulations could also allow employers to tailor what workers have access to the benefit. But this could lead to uneven access, Yin said. For example, companies may offer the benefit only for higher income professionals.
Would supplemental insurance reduce the cost of fertility treatment?
It’s complicated and unclear. Most patients cite high costs as the main reason they don’t seek fertility treatment, said Usha Ranji, associate director with KFF’s Women’s Health Policy Program.
“Any assistance with the out of pocket costs can be helpful,” she said.
And yet, supplemental policies oftentimes aren’t subsidized by the employer, said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms. That means if an employer did offer supplemental fertility care, it would likely come at a high cost.
In the case of major medical insurance, healthy people are partially subsidizing sicker people, Corlette said, “and the insurance company is counting on having a mix of healthy people to do that.”
But people who are not looking for IVF or other fertility care would likely not opt into the supplemental plan.
“Without any subsidization from the employer or subsidization from the people who are not going to be using these services,” this could mean, for many people, “they might as well just pay out of pocket for the IVF services,” Corlette said.
Given the option of offering fertility care separately, some employers who currently cover fertility care under their general health insurance may opt to stop.
“In which case, people who do need IVF services could find that they’re paying a lot more,” Corlette added.
Can the Trump administration propose this rule without congressional oversight?
Excepted benefits were established under a decades-old federal law. Amending excepted benefits to include fertility care wouldn’t require congressional approval, Ranji said.
Tipton of the American Society for Reproductive Medicine said “that’s part of the appeal” for the administration. He added that his organization advocates for Congress to pass a bill that would require all health insurance to cover IVF. That would include people enrolled under the Affordable Care Act.
But the Trump administration’s proposed rule doesn’t apply to that group, Ranji said.