IVF and fertility coverage by FEHB plan for 2027

Drugs yes, procedure no

Every FEHB carrier must cover artificial insemination, the drugs that go with it, and IVF-related drugs for three cycles a year. No carrier is required to pay a penny toward the IVF procedure itself.

That is the whole structure, and it has not changed for 2027. OPM's guidance to carriers for the 2027 plan year encourages them to negotiate discounts on assisted reproductive technology they do not cover, and requires their network fertility clinics to meet reporting standards — but it stops short of requiring the treatment.

So when a plan advertises fertility coverage, the first question is not how much. It is whether it covers the procedure at all, or only the medication.

What each plan pays in 2027

Compass Rose High Option published a $5,000 annual infertility allowance for 2026. We could not confirm the 2027 figure, so treat the 2026 number as last year's until you have checked.

Regional HMOs sometimes carry much larger IVF allowances than any nationwide plan. If an HMO operates where you live, it is worth reading its 2027 brochure before settling for a nationwide plan.

The GEHA trap

GEHA's 2027 infertility policy covers IVF under FEHB High Option and under PSHB Standard Option. Same carrier, same $25,000, different option name depending on which programme you are in.

If you are a non-postal federal employee and you read advice saying "GEHA Standard covers IVF", that advice is about the postal programme and it is wrong for you. Picking GEHA Standard would leave you with the drug benefit and nothing toward the procedure.

This is the single easiest way to get this decision wrong, because the two programmes share a carrier name, a website and most of their documents.

The default that could cost you a cycle

Nine FEHB plans end on December 31, 2026. Their enrollees are automatically moved into Compass Rose Standard Option unless they choose otherwise during Open Season.

Compass Rose Standard covers infertility treatment up to $1,000 a year. If you are mid-treatment in a terminating plan and you do nothing, you begin January with a $1,000 annual allowance and a fresh prior-approval requirement.

Anyone planning treatment in 2027 should check whether their plan is on the terminating list before anything else. The list and the deadlines are here.

Where the money leaks

• The provider tier, not just the network. FEP Blue Standard publishes its 15% IVF cost share for a Preferred provider. A provider who is in network but only Participating generally costs more under this plan, so confirm the rate for your specific clinic before a cycle starts. How tiering works is here.
• GEHA pays for fertility drugs only through the pharmacy benefit. Its policy states medications are not covered when dispensed by other sources. Drugs administered at the clinic or in the physician's office come out of your pocket entirely.
• Drug authorisation is not treatment authorisation. GEHA states plainly that authorising fertility medication does not imply authorising any related procedure. Two approvals, two decisions.
• The cap may include more than you think. GEHA's $25,000 is inclusive of supplies and related facility and anaesthesia charges, not just the procedure fee.
• Donor eggs and donor sperm are generally not covered, nor are surrogacy costs or services for anyone not enrolled in the plan.
• Eligibility gates come before money. GEHA requires three unsuccessful insemination attempts or a qualifying diagnosis before ART, and defines infertility as 12 months of trying under age 35 but six months at 35 or older.

Switching plans mid-treatment

These allowances are annual, not lifetime. They reset each January, which means a cycle spanning December and January can in principle draw on two plan years.

That only works if you stay put. Every plan that covers IVF requires its own prior approval, and approvals do not transfer between carriers. Switch in January and you need a fresh authorisation from the new plan before treatment continues, and your deductible restarts.

We could find no OPM or carrier statement about crediting amounts already spent against a new plan's maximum, so do not assume anything carries across. If you are mid-cycle, the safe move is to ask both carriers in writing before Open Season closes on December 14.

One timing note that does work in your favour: if you are paying for treatment out of pocket, an FSA can cover eligible costs with pre-tax money, and FSAFEDS must be re-elected every year or it lapses entirely.

Fertility preservation

Where a medical treatment is going to cause infertility — chemotherapy being the usual case — the major plans cover procurement of sperm and eggs, cryopreservation and a period of storage. Blue Cross and APWU both list it in their 2027 brochures as requiring prior approval, which tells you it is a covered benefit in those plans.

The details vary. GEHA allows one successful preservation cycle per person across the enrollment period, with up to three retrieval attempts and twelve months of storage. APWU published a $12,000 lifetime maximum per person. Blue Cross covers storage once per lifetime for a year.

Elective egg freezing for age-related reasons is a different thing and is generally not covered.

Prior approval is required for preservation in most plans. If treatment is imminent, get the authorisation started before the first appointment, not after.

Common questions