AOC and the cost of egg freezing: What you need to know about insurance and taxes

Rep. Alexandria Ocasio-Cortez recently announced on social media that she would freeze her eggs, calling attention to the cost of the procedure. The Democratic congressman from New York’s 14th Congressional District said in an Instagram Story that the decision “took time to think, reflect, and save.”

Research shows that so-called selective egg freezing is becoming more common as women delay motherhood to focus on education and careers. Ocasio-Cortez, 36, recently said on ABC’s “This Week” that she hasn’t ruled out a future presidential or U.S. Senate campaign.

But the cost of egg freezing, combined with the lack of widespread insurance coverage, remains a barrier for many women.

“Egg freezing cycles typically cost between $10,000 and $20,000 in the United States,” said Dr. Stephanie Kuku, a retired gynecologist and senior advisor to the World Health Organization. If multiple cycles are required, the total tab can be even higher when considering additional costs such as storage and transplantation.

Kuku, who has also worked with several technology companies on projects related to IVF accessibility, found in her new research that reducing the cost of infertility treatment increases birth rates.

For comparison, in France, selective egg freezing is fully covered by the country’s public health insurance.

Natalie Lampert, author of The Big Freeze, said egg freezing is primarily positioned as a technology that gives women “more reproductive options.”

“But that option remains disproportionately available to those who can afford it or receive sufficient reproductive subsidies,” Lampert said.

Ocasio-Cortez did not respond to requests for comment.

According to FertilityIQ, a fertility data and education platform, one egg freezing cycle, which includes hormone stimulation and retrieval procedures, costs about $16,000 on average. Prices vary widely depending on location.

But many women need multiple cycles to get the number of eggs they want, says Dr. Marcel Cedars, professor and director of the Center for Reproductive Health at the University of California, San Francisco. Ideally, women under 35 should freeze at least 20 eggs, Cedars said. Women over that age usually require a higher number.

According to an analysis by FertilityIQ, the total cost of egg freezing for a 38-year-old woman in New York City, which requires three cycles, could reach $47,000.

Age isn’t the only thing that affects the number of cycles you need. The patient’s overall health and facility technology are also factors.

“For those who are uninsured, the combination of upfront costs and uncertainty can make the decision especially difficult,” said Daniel Melfi, CEO of RESOLVE, the National Infertility and Family Building Association.

Ocasio-Cortez said on social media that “my insurance won’t cover a penny” for egg freezing surgery.

In fact, health insurance coverage for selective egg freezing remains the exception rather than the rule, Melfi said. But she added: “Where we’re seeing meaningful growth is through workplace benefits.”

About 22% of employers with 500 or more employees will offer coverage for elective egg freezing in 2025, up from 5% in 2015, Mercer said. Last year, 40% of companies with 5,000 or more employees offered this benefit, compared to just 8% a decade ago.

Even for companies that cover egg freezing, lifetime benefits of up to about $20,000 are typical, Mercer said.

Melfi said people who don’t have workplace health insurance typically have to pay for the entire process out of pocket.

In the Affordable Care Act market, “there are no established federal requirements for plans that cover in vitro fertilization or selective egg freezing,” she said. And no state covers elective egg freezing for Medicaid recipients.

There is one exception. More than a dozen states require fertility preservation insurance before certain treatments, such as chemotherapy, that can affect the body’s ability to produce sperm or eggs, Melfi said. But even this protection does not extend to all plans, she added.

After egg retrieval surgery, women typically have to pay an ongoing fee to store their eggs, said Carolyn McClanahan, a physician and certified financial planner and founder of Life Planning Partners in Jacksonville, Florida.

These costs also vary by location. According to FertiltyIQ, storing it for five years in New York City, for example, can cost $5,500.

“And of course, if you decide to use the eggs, you’ll have to pay to have them thawed and implanted,” said McClanahan, a member of the CNBC Council of Financial Advisors. “Of course, that costs a lot of money.”

As a result, most couples try to conceive naturally before using frozen eggs or embryos. Health insurance coverage for IVF is more commonly due to infertility than personal choice.

McClanahan said people who decide to freeze their eggs also need to consider taxes.

If a company pays for elective egg freezing, the benefits “count as earned income and are taxed,” she says. In such cases, your employer will likely add the benefits to your W-2.

This could result in a large amount of tax. In McClanahan’s example, for $20,000 in benefits, a single woman earning $80,000 a year would owe an additional $4,400 to the IRS.

If you freeze your eggs because of a medical condition, the cost may be deductible as a medical expense, McClanahan said.

“If a woman is diagnosed with cancer and her treatment affects her future fertility, that would be deductible,” she says. “Freezing your eggs because you want to delay childbirth is considered a personal choice and is not deductible.”