The LGBTQ+ community has made great strides, but plenty of challenges remain. One often overlooked issue is insurance coverage for fertility treatments. While all couples face hurdles in this area, LGBTQ+ people encounter extra obstacles.
As things stand, only 19 states require insurers to cover fertility treatments. Even fewer offer equal access to LGBTQ+ people. With IVF costing up to $30,000 per cycle, insurance coverage is essential for those looking to grow their families without tapping into their savings or going into debt.
In this article, we’ll explore how LGBTQ+ people are excluded from fertility benefits, highlight states with equal coverage, discuss positive developments, and offer alternative ways to fund fertility treatments.
How Are LGBTQ+ People Excluded from Fertility Benefits and Insurance Coverage
Most health insurance companies require policyholders to demonstrate infertility to access fertility treatment benefits. Typically, infertility is defined as the failure to get pregnant after 12 months or more of regular, unprotected sex.
The problem is that this definition is based on the experiences of heterosexual, cisgender couples. It inherently excludes LGBTQ+ couples, single parents-to-be, and anyone pursuing parenthood outside of a traditional heterosexual partnership.
For LGBTQ+ people, this means paying out-of-pocket for fertility treatments like intrauterine insemination (IUI), in vitro fertilization (IVF), or reciprocal IVF for a year or more before insurance benefits become available. This financial burden creates significant hurdles for those trying to conceive.
States That Provide LGBTQ+ Fertility Insurance Coverage
While most states don't have laws in place to cover LGBTQ+ people seeking fertility treatment, some are leading the way.
Currently, the following states require insurers to provide equal fertility treatment benefits to LGBTQ+ individuals and couples:
California
Colorado
Delaware
Illinois
Maine
Maryland
New Jersey
New York
Washington D.C.
Additionally, Connecticut recently passed a law granting equal access to coverage set to take effect on January 1, 2025.
Looking ahead, Massachusetts and Rhode Island are considering broader IVF coverage mandates that would explicitly include queer couples.
Positive Developments in LGBTQ+ Fertility Insurance Coverage
For many years, the American Society for Reproductive Medicine (ASRM) followed the heterocentric definition of infertility. In other words, infertility meant the inability to conceive after a year or more of unprotected sex.
In October 2023, the ASRM made a significant update to this definition. The new definition includes "the need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner” as part of the infertility criteria.
Importantly, the organization emphasized that this updated definition should not “be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”
Another positive development came in April 2024 when the U.S. Departments of Defense and Veterans Affairs announced expanded IVF coverage benefits. These federal agencies now provide coverage regardless of a patient’s marital status, sexual orientation, or use of donor eggs or sperm.
As the largest employer in the country, this move sets an important precedent. It may pressure other states and employers to follow suit and offer more inclusive fertility benefits for LGBTQ+ individuals and couples.
Alternate Options for LGBTQ+ Fertility Insurance Coverage and Treatment Funding
While progress is being made, the lack of equal insurance coverage in many states means LGBTQ+ people will need to keep looking for other ways to fund fertility treatments. These can include:
Offered by non-profit organizations and religious groups, these scholarships cover some or all of a patient’s fertility expenses.
Financing Programs:
Provided by banks, pharmaceutical companies, and fertility clinics, these programs offer payment plans and loans to help manage fertility treatment expenses.
Tax-Advantaged Accounts:
Flexible Spending Accounts (FSAs):
Allow pre-tax contributions to be used for qualified medical costs, including fertility care.
Health Reimbursement Accounts (HRAs):
Employer-funded accounts for workers to spend on medical expenses.
Health Savings Accounts (HSAs):
Designed for people with high-deductible health plans to pay for qualified medical procedures.