Most people who freeze their eggs pay out of pocket. But if you’re freezing because of cancer, autoimmune disease, or another medical condition, that might not be true — and not knowing the difference could cost you $6,000 to $15,000.
The insurance landscape for egg freezing splits cleanly into two categories: medical necessity freezing and elective social freezing. They’re treated almost entirely differently by insurers, and understanding which category you fall into is the first step.
Medical Necessity Egg Freezing: Often Covered
When egg freezing is done to preserve fertility before a medical treatment that would damage or destroy ovarian function, it’s called fertility preservation or oncofertility. Common situations:
- Cancer patients before chemotherapy or radiation that would affect ovarian function
- Patients before surgery to remove ovaries (oophorectomy)
- Patients with autoimmune conditions requiring gonadotoxic treatments (like cyclophosphamide for lupus)
- Some genetic conditions where early menopause is expected
The American Society of Clinical Oncology (ASCO) established guidelines in 2006 (updated 2018) that fertility preservation should be discussed with all cancer patients of reproductive age before starting treatment. These guidelines — and the growing body of oncofertility research — gave insurers and regulators the clinical framework to justify coverage for medical-necessity freezing.
According to ASCO’s 2018 clinical practice guideline update, fertility preservation referral should be made “as early as possible” for all patients newly diagnosed with cancer who may want future children. This isn’t optional guidance — it’s standard of care.
How to Get Medical Necessity Coverage
If you’re facing cancer treatment or another medical situation, here’s how to pursue coverage:
Step 1: Get a referral from your oncologist or treating physician. A referral from the physician ordering the treatment that will affect your fertility carries significant weight. It documents that egg freezing is medically indicated in the context of your care.
Step 2: Ask your reproductive endocrinologist (RE) for a letter of medical necessity. This letter should explain your diagnosis, why your fertility will be at risk, and why egg freezing is the appropriate intervention. Include specific ICD-10 diagnosis codes (e.g., Z31.62 for female infertility due to conditions classifiable elsewhere).
Step 3: Submit a prior authorization request. Before any procedures, submit to your insurer with the oncologist’s referral, the RE’s medical necessity letter, and your diagnosis documentation. Request written approval before proceeding.
Step 4: Know your appeal rights. If the prior authorization is denied, you have the right to appeal. Medical necessity cases have a strong track record on appeal, particularly when the underlying condition is unambiguous (e.g., a cancer diagnosis).
Common codes used in fertility preservation prior auth requests: Z31.62 (female infertility in diseases classified elsewhere), Z79.899 (other long-term current drug therapy — for patients on gonadotoxic medications), and the primary diagnosis code for the underlying condition (e.g., C50.x for breast cancer). Your RE’s billing team will know the right codes for your situation.
Elective (Social) Egg Freezing: Rarely Covered
If you’re freezing your eggs for non-medical reasons — most commonly to extend your reproductive options while pursuing career, relationships, or personal readiness — insurance almost never covers it.
The term “social egg freezing” is used to distinguish from medical necessity. Most commercial insurance plans explicitly exclude elective egg freezing. ACA marketplace plans don’t mandate coverage for elective freezing.
Exceptions:
Some large employers cover elective egg freezing as part of their fertility benefits package. Apple and Facebook made headlines for offering this in 2014; many large tech and finance companies have followed. If your employer has a fertility benefit through Progyny, Carrot Fertility, or a similar platform, elective freezing may be included in your benefit.
A small number of state fertility insurance mandates have been interpreted to include fertility preservation for non-medical reasons in certain circumstances — but this is the exception, not the rule.
| Egg Freezing Type | Typical Coverage | Out-of-Pocket Cost |
|---|---|---|
| Medical necessity (cancer/medical) | Often covered with prior auth | $0–$3,000 (deductible/copays) |
| Employer fertility benefit | Covered up to benefit limit | $0–$5,000 depending on limit |
| Elective (no employer benefit) | Rarely covered | $6,000–$15,000 per cycle |
| Elective (mandate state, fully-insured) | Sometimes covered | $500–$4,000 |
States That Mandate Egg Freezing Coverage
A handful of states now explicitly require coverage for fertility preservation, including egg freezing:
New York — Mandates fertility preservation coverage for patients facing iatrogenic infertility (fertility loss from medical treatment). This covers cancer patients and others facing gonadotoxic treatment.
New Jersey — Includes fertility preservation in its fertility coverage mandate. Medical necessity is required.
Illinois — Covers fertility preservation under its broader infertility mandate.
Colorado — Its 2022 fertility mandate includes fertility preservation for medical necessity.
Connecticut, Maryland — Include fertility preservation provisions in their fertility mandates.
Even in mandate states, the protection typically covers medical necessity situations — not social freezing. The mandate triggers when treatment will “directly or indirectly cause iatrogenic infertility,” per most state law language.
The Annual Storage Cost Problem
One thing to be aware of: even if egg retrieval and freezing are covered, annual storage fees are almost never covered by insurance. Typical storage costs $500–$1,000 per year. If you end up storing eggs for five to ten years, that adds up regardless of your initial coverage situation.
Check explicitly whether your coverage includes storage, and for how long. Many fertility benefit plans cover retrieval and initial freezing but exclude ongoing storage.
What If You’re On Medicaid?
Medicaid coverage for egg freezing is extremely rare. A few state Medicaid programs have expanded reproductive health coverage, but medically necessary egg freezing isn’t consistently covered even in states with fertility mandates. If you’re on Medicaid and facing cancer treatment, work with your oncology social worker — many cancer centers have access to fertility preservation assistance programs that can bridge the gap.
Organizations like Fertile Hope (now part of Livestrong Foundation) and the Alliance for Fertility Preservation offer financial assistance and navigation support for patients who need fertility preservation before cancer treatment.
Bottom Line
If you’re freezing because of a medical necessity, pursue coverage aggressively — you have a real chance of getting it paid for, and the documentation process is manageable. If you’re freezing electively, start by checking your employer benefits before assuming you’ll pay out of pocket. Either way, know the difference before you call your insurance company — asking the right question matters.
ASCO oncofertility guidelines referenced: American Society of Clinical Oncology Clinical Practice Guideline Update on Fertility Preservation for Patients with Cancer (2018). State mandate data current as of 2025; verify with your state insurance commissioner or RESOLVE.