Under D.C. Law 25-49 (effective September 6, 2023), large-group health plans must cover infertility diagnosis and treatment from January 1, 2025, including IVF with at least 3 complete egg retrievals and unlimited embryo transfers, plus fertility preservation. The same coverage for individual and small-group plans depends on budget funding. Since January 1, 2024, DC Medicaid and the DC Healthcare Alliance cover diagnosis and fertility drugs, but not IUI or IVF. Picture as of October 2026.
| Who | What DC requires | Since |
|---|---|---|
| Large-group plans | Diagnosis and treatment of infertility, including IVF and standard fertility preservation; at least 3 complete egg retrievals with unlimited embryo transfers (ASRM guidelines, single embryo transfer when recommended); medical costs of transferring an embryo to a third party | January 1, 2025 |
| Individual and small-group plans | Same coverage written into the law, but it applies only once its cost is included in an approved budget certified by the Chief Financial Officer | Contingent |
| DC Medicaid managed care and the DC Healthcare Alliance | Male and female diagnostic tests without prior authorization; fertility drugs limited to 3 treatment cycles per lifetime; IUI and IVF not covered | January 1, 2024 |
Sources: D.C. Law 25-49, Expanding Access to Fertility Treatment Amendment Act of 2023; DC Department of Health Care Finance, Transmittal 24-15 (June 2024).
The law also bars discrimination by age, marital or domestic partner status, sex, sexual orientation, gender identity and other characteristics, and forbids different cost-sharing or waiting periods, pre-existing condition exclusions, and arbitrary limits based on number of attempts, dollar amounts or age.
In April 2024 DC's insurance regulator (DISB) announced it would apply to add all infertility services, including IVF and fertility preservation, to the District's 2026 essential health benefits benchmark; until then the benchmark covered only diagnosis, testing and counseling. healthinsurance.org reports that the benchmark is expanding in 2026 (June 2026), but this was not confirmed on a DISB or federal page.
Even in DC, a state-level mandate does not apply to self-insured employer plans, which cover 67% of US workers with employer coverage (healthinsurance.org, June 2026). Your plan documents or HR department can tell you whether your plan is self-insured.
DC's Medicaid benefit covers diagnosis and ovulation drugs, which Map to the Positive places on the first rungs of treatment. The book lists the main medications that stimulate ovulation in women with ovulatory dysfunction:
Combined with monitoring and guidance on timing, the book gives a success rate per cycle of 10% to 15% for couples with an isolated ovulatory factor, and suggests 3 to 6 cycles before moving up the ladder.
Ovulation induction and the full treatment ladder are in Chapter 34 of Map to the Positive, in Station IV. The same station covers when to see a specialist, how to choose a doctor and what happens in each phase of IVF.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: D.C. Law 25-49, Expanding Access to Fertility Treatment Amendment Act of 2023 (D.C. Law Library) (2023-09-06) · Transmittal 24-15 (rev): Fertility Diagnosis and Treatment Coverage (DC Department of Health Care Finance) (2024-06-25) · Essential Health Benefits benchmark 2026: request for comments (DC Health Link / DISB) (2024-04-26) · Q. Does the ACA require infertility treatment to be covered by health insurance? (healthinsurance.org) (2026-06-18)