California’s new law mandating insurance coverage for in vitro fertilization (IVF) has expanded access for many, but significant gaps remain that leave numerous individuals and families facing prohibitive costs. The legislation, signed by Governor Gavin Newsom and effective since January 2026, requires insurers to cover IVF and related fertility services for employees of large companies with 100 or more workers, as well as public employees covered under the California Public Employees’ Retirement System (CalPERS). However, it does not apply to workers in small businesses, those with individual or marketplace insurance plans, Medi-Cal recipients, military personnel, self-insured employer plans, or the uninsured.

Nicole Torres, an accountant from Ontario, California, learned she was excluded from the new IVF coverage because she worked for a small brewery. After receiving a denial notice from her insurance provider, Torres began searching for employment with companies offering fertility benefits, concerned about the time-sensitive nature of her fertility challenges at age 40. “Why do some people get this benefit when other people don’t? We’re all struggling with the same infertility, the same heartache,” she said.

Historically, IVF has largely been accessible only to wealthier populations, creating disproportionate barriers for minorities. Studies have shown that Black and Latino women in the United States are significantly less likely to receive infertility treatments compared to white women. Over the past two decades, an increasing number of employers and states have broadened fertility coverage, contributing to a record number of more than 100,000 IVF babies born in the U.S. in 2024.

California’s SB 729 is considered one of the most inclusive state laws to date. It extends coverage to LGBTQ+ individuals and single people, groups often excluded under traditional definitions of infertility that focus on failure to conceive through heterosexual intercourse. The mandate requires coverage of up to three egg retrievals and unlimited embryo transfers, among other services.

Despite the progress, experts warn that delays in treatment due to insurance uncertainties pose challenges. “People say, ‘I certainly don’t want to pay for it out of pocket if I’m going to have coverage in the future. I want to delay this.’ But that’s a bit of a gamble because time is just never on anyone’s side,” said Marc Kalan, co-founder of the Los Angeles Reproductive Center. Fertility clinics in the Los Angeles area report a roughly 20% increase in patients since the law’s implementation, including individuals who had postponed care for financial reasons.

Gaps in coverage persist, notably concerning services related to donor eggs, sperm, embryos, or gestational carriers. While insurers must cover medical procedures involved in donor-related treatments, they do not typically pay for donor compensation, legal fees, or surrogate pregnancy costs, potentially adding tens of thousands of dollars to patient expenses. Coverage for ancillary procedures such as genetic testing and certain fertility techniques can also be denied or require patients to try less effective, less costly methods first.

Advocates emphasize that the law’s limitations arise in part from legal constraints, with some insurance markets under federal jurisdiction. Additional legislation aims to extend coverage to small-group and individual plans through the Affordable Care Act, but federal approval is pending. Meanwhile, a Trump-era federal proposal allowing employers to voluntarily offer separate fertility benefits remains unfinished.

The financial burden of fertility treatment leads some individuals to seek alternative means of funding, including loans, credit cards, home equity, or even obtaining medications through informal channels. Employment decisions are also influenced by access to fertility benefits, with some patients accepting jobs not ideally suited to their careers or personal lives to secure coverage.

For individuals like Michele Metz of Murrieta, insurance coverage can be transformative. After spending nearly $100,000 on unsuccessful IVF treatments and facing ongoing payments, Metz’s husband’s employer recently qualified under California’s mandate. She described the insurance coverage as enabling her to pursue IVF with donor eggs and increasing their chances of parenthood. “Without it, I don’t know if I would have had to make peace without kids,” Metz said.

As California’s mandate begins to take effect, the state grapples with balancing expanded access to fertility treatment with ongoing challenges faced by many who remain outside the scope of coverage.