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Last revised March 13, 2023

Legacy and Carrot survey: Most people want fertility benefits

We’ll be the first to admit it, healthcare and fertility treatments — especially in the United States — are not cheap. Bloodwork, egg retrieval, monitoring appointments, and follow-up appointments start to add up really quickly. One round of in vitro fertilization (IVF) will typically cost $15,00–$20,000, but can even go as high as $30,000+. Now consider that individuals may need to complete several rounds of IVF before they are successful. It becomes clear pretty quickly how important it is for health insurances and/or employers to financially support those seeking treatment. 

While many Americans receive covered healthcare services through their employer or a government-run program (like Medicare or Medicaid), many are forced to foot the entire bill when it comes to fertility treatment. Luckily, as the conversation around fertility challenges becomes less stigmatized, more and more people are getting covered access to critical fertility treatment services.

Key takeaways

  • Despite the growing infertility problem and high cost of fertility services, many employers — especially those with under 20,000 employees — do not offer fertility benefits.
  • Most people value fertility benefits and consider the availability of these benefits when making employment decisions.
  • Companies that offer fertility benefits are the most competitive in a tight labor market and can attract top talent. 
  • Fertility benefits are not required to be covered by insurance plans in most states; currently only 15 states have mandates for coverage of fertility treatments.

Legacy and Carrot’s survey

Anyone who has looked into the cost of in vitro fertilization (IVF) or other fertility treatment services can attest to the fact that costs start to add up pretty quickly. But who should foot the majority of the bill? Health insurance providers? Employers? The individuals seeking treatment?

Curious about the evolving trends, we set out to learn more about fertility benefit coverage in the United States. In October 2022, we sent out a survey asking individuals about their healthcare benefits. We received 2,983 responses from respondents between the ages of 18 and 65. Of the group, 50% identified as cisgender men, 48% as cisgender women, and 2% as trans or nonbinary.* These were our findings. 

*Note: when we refer to “women” and “men,” we include all people who self-identify as such.

Fertility benefits are still not the norm

If you’re facing infertility, you’re not alone. Studies show that infertility impacts 15% of couples — around 6.7 million people — in the United States alone. Male-factor infertility is the primary contributor for around one-third of these cases. 

Birth rates are on the decline globally, due in part to the decline in sperm count and quality. As infertility continues to affect more and more couples and medical advancements in fertility treatments accelerate, fertility benefits may become more commonplace and play a bigger role in hiring and recruitment initiatives. 

Fertility benefits refer to an umbrella of employer-covered treatments and services to help individuals throughout their family-building journey, from planning to parenthood. Some common services include:

The cost of these services and treatments is prohibitively expensive — sometimes requiring multiple treatments or attempts — for many individuals, thus making the employer coverage that much more critical. However, of those surveyed, only around one-third of respondents who were employed full time reported that their companies offered coverage for fertility testing and treatment. 

Many large employers are considering how offering fertility benefits can help them get ahead in a tight labor market. In one survey conducted by Mercer in 2020, 42% of employers with 20,000 employees or more offered coverage for in vitro fertilization. Access to these benefits continues to disproportionately exclude individuals who work for smaller companies, are contractors or freelancers, or rely on government-run insurance programs, like Medicaid. 

Most people think fertility benefits are important

Despite the lack of comprehensive coverage, most people value fertility benefits, with 55% of Legacy’s survey respondents reporting that they believed it was important for employers to offer female fertility benefits. Our survey also showed that 50% of respondents believed it was important for employers to offer male fertility benefits. The availability of fertility benefits plays a significant role in employee retention and loyalty. One in three respondents from our survey said that fertility benefits would be likely or extremely likely to sway their employment decisions. 

Companies that offer fertility benefits need to make those benefits clearer

Given the attractiveness of fertility benefits for potential employees and the relatively limited number of companies that offer these benefits — especially among smaller-sized companies — those that do offer fertility benefits can stand out by making these offerings clear and advertising them in hiring materials. More than one in three respondents from our survey weren’t sure if their employer offered fertility benefits. 

Educating employees about the details of these benefits, including who is eligible, the extent of the coverage, and how to get more information, can go a long way in increasing employee awareness and utilization. Given the personal nature of these treatments, like with any other medical benefit, employers should clearly communicate the privacy and anonymity of using fertility treatment services offered through a benefits package. 

Diversity, equity, and inclusion (DEI) efforts have been top of mind for employers seeking to attract and retain individuals who have historically been underrepresented and marginalized in the workplace. Fertility benefits are an important part of these efforts, supporting LGBTQ+ individuals and couples — those who may be excluded from traditional health insurance coverage requirements — in their family planning journey. Additionally, as more companies begin to offer fertility benefits and it becomes the norm, it may become discriminatory to not offer these benefits. 

Types of fertility coverage

Insurance coverage for fertility testing and treatment

There are only 15 states that legally require health insurance to cover some fertility treatments: Arkansas, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Utah, and West Virginia. Even in these states, “mandate to cover” laws only apply to some insurers and qualification restrictions, leaving many without coverage. 

As fertility benefits become more widespread, more states are adopting laws to expand coverage. Arizona, Iowa, Michigan, Missouri, Nevada, North Carolina, Pennsylvania, Tennessee, Virginia, and the District of Columbia have all adopted a benchmark plan to provide coverage for some fertility services, including diagnosis and treatment through individual and small group plans. 

Government and legislative mandates are necessary to ensure equitable access across socioeconomic and racial divides. Until these are adopted, the onus falls on employers and individuals to cover the cost of services. 

Fertility benefits programs

Many companies may use fertility benefits programs, like Carrot, to manage and administer their fertility benefit offerings. These programs typically offer a range of services from fertility planning and care to donor assistance and adoption support — meeting every employee wherever they are on their family-forming journey.  

Fertility benefit programs offer an integrated approach to providing fertility care, working alongside insurance providers and clinicians to provide effective and specialized family-building services with improved outcomes.

When employees feel emotionally and financially supported in their family planning and healthcare decisions, they are empowered to make decisions that lead to healthier outcomes. Comprehensive coverage options have also been reported to reduce healthcare costs for employers.  

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