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Insurance & Cost· November 1, 2026· 6 min read
End-of-Year Fertility Benefits & FSA/HSA: How to Maximize Your Coverage Before December 31
Met your deductible or have FSA money left? How to use fertility benefits, FSA and HSA funds before December 31, from Dr. Chauhan in Houston & Sugar Land.
November is when a lot of patients start asking the same question: should I start fertility care now, or wait until January? For many people, the answer depends on their benefits. Deductibles, out-of-pocket maximums, and flexible spending accounts all run on a plan-year calendar, and for most plans that calendar ends December 31.
This guide walks through what the official rules actually say, so you can make a decision with real information.
Why the end of the year matters
Your deductible. HealthCare.gov defines a deductible as the amount you pay for covered health care services before your insurance plan starts to pay. After you meet it, you usually pay only a copayment or coinsurance for covered services.
Your out-of-pocket maximum. This is the most you have to pay for covered services in a plan year. Once you reach it, your plan pays 100% of covered services for the rest of that plan year.
Both reset when a new plan year begins. If you have already met your deductible, or are close to your out-of-pocket maximum, covered visits and testing before your plan year ends may cost you less than the same care in January. Check your plan documents to confirm your plan year dates and what counts as covered.
Open enrollment: what to look for
If you are choosing a plan for next year, read the fertility section of each option carefully. Questions worth asking:
- Does the plan cover diagnostic testing for infertility (bloodwork, ultrasound, semen analysis)?
- Does it cover treatment, such as IUI or IVF, and are there lifetime or per-cycle limits?
- Is fertility medication covered, and through which pharmacy?
- Is prior authorization or a referral required?
- Does your employer offer a separate fertility benefit through a third-party administrator?
Using FSA and HSA dollars for fertility care
IRS Publication 502 lists the medical expenses the IRS treats as qualified. Under Fertility Enhancement, it states you can include the cost of procedures performed on yourself, your spouse, or your dependent to overcome an inability to have children, including:
- Procedures such as in vitro fertilization (including temporary storage of eggs or sperm)
- Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children
Qualified medical expenses can generally be paid from a health FSA or HSA. Your specific plan administrator decides what documentation it needs, so keep itemized receipts.
FSA "use it or lose it": know your plan's rule
According to IRS Publication 969, FSAs are generally "use-it-or-lose-it" plans: money left at the end of the plan year generally can't be carried over. However, an employer's plan may offer one of two exceptions (not both):
- A grace period of up to 2½ months after the plan year ends, during which you can use leftover funds for qualified expenses.
- A carryover of a limited amount of unused funds into the next plan year. Anything above the carryover amount is forfeited.
Your HR department or FSA administrator can tell you which option, if either, your plan uses and your exact deadline.
HSAs work differently. Publication 969 notes that HSA contributions remain in your account until you use them, and amounts left at the end of the year are generally carried over. There is no year-end deadline to spend HSA funds.
Annual FSA and HSA contribution limits are set by the IRS and change each year. Check the current figures with your plan administrator or at IRS.gov before choosing your election.
A note for Texas patients
Texas Insurance Code Chapter 1366 requires issuers of group health plans that provide pregnancy-related benefits to offer coverage for outpatient in vitro fertilization expenses to the employer or plan sponsor. A rejection of that offer must be in writing. This is a requirement to offer coverage, not a requirement that every plan include it.
When the coverage is in place, the law lists conditions, including:
- The patient's eggs are fertilized only with the sperm of the patient's spouse
- A history of infertility of at least five continuous years, or infertility associated with endometriosis, in-utero DES exposure, blocked or removed fallopian tubes, or oligospermia
- The patient has been unable to achieve a successful pregnancy through less costly covered infertility treatments
- Treatment is performed at a facility meeting ASRM minimum standards for IVF programs
The law also exempts certain religiously affiliated issuers, and it applies to employer plans only to the extent federal ERISA rules permit. Ask HR whether your plan is fully insured or self-funded, and whether IVF coverage was offered and accepted.
Questions to ask your insurer or HR this month
- What are my plan year start and end dates?
- How much of my deductible and out-of-pocket maximum have I met?
- Does my FSA have a grace period, a carryover, or neither?
- Which fertility diagnostics and treatments are covered next year?
- Do I need a referral or prior authorization?
How to get started before December 31
The first step is a consultation and a diagnostic workup, which tells you where you stand before you spend on treatment. At New Hope Fertility Institute of Texas, Dr. Subodh Chauhan sees patients in our Houston and Sugar Land offices. Pricing for any treatment is discussed and agreed upon with you before it begins.
Holiday schedules fill quickly. Book your consultation or learn more about our diagnostic workup.
This article is for general information only and is not tax, legal, or insurance advice. Benefit rules vary by plan. Confirm details with your plan administrator, HR department, or a tax professional.
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