LGBTQ+ Fertility Costs & Open Enrollment: What You Need to Know

How do you know what’s covered and how much will this journey actually cost?

How can you optimize your coverage and advocate for yourself?

Fertility Treatment & the LGBTQ+ Community

Despite the fact that 63% of LGBTQ millennials plan to use assisted reproductive technology (ART) to build their families, many insurance companies still use outdated criteria that limits access to family-building treatment (such as IVF) to opposite-sex couples only.

If this feels discriminatory and unfair - it is. Thankfully, many organizations and advocates are continuing to work hard to help ALL families access the family-building coverage they deserve.

For years, infertility was defined as the inability to conceive after a year or more of egg and sperm exposure, which excludes millions of single people and members of the LGBTQ+ community in same-sex partnerships. In fact, most of us aren’t “infertile” at all – we just need a little bit of extra help to expand our families.

Expanding the Definition of Infertility

On October 15, 2023, the American Society for Reproductive Medicine (ASRM) Practice Committee issued a new definition of infertility. 

Infertility is a disease, condition, or status characterized by any of the following:

• The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
• 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.
• In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at six months when the female partner is 35 years of age or older. 

Most importantly, ASRM adds, "Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation."

In simpler terms: The official definition of infertility has now been expanded to include anyone needing medical interventions "in order to achieve a successful pregnancy either as an individual or with a partner," according to ASRM.

How will this impact me?

Great question - with a somewhat complex answer. Insurance companies do consider ASRM's guidelines when developing their policies and plans. However, this doesn't mean that every insurer will immediately shift their criteria on who qualifies for fertility treatment.

However, as someone who built his own family with the help of egg donation and surrogacy, I do feel optimistic and hopeful about these recent changes.

Everyone who desires to be a parent is included in this new definition of infertility.

This will likely pressure corporations that offer infertility benefits to include single individuals and LGBTQ+ parents-to-be; which should lead to change across the country and improve overall access to care.

Questions to Ask Your Insurer 

How can you find out if family-building is covered for you and your partner? The best way to figure out your own insurance coverage is to call the number on the back of your card!

The following list of questions is a great guide for that conversation:

• Do I have coverage for diagnostic testing for infertility treatment?
• Do I have coverage for fertility treatments? Intrauterine insemination (IUI) coverage? In vitro fertilization (IVF) coverage? If so, how many cycles are covered for each?
• Do I have IUI/IVF coverage? If so, how many cycles are covered for each?
• Is cycle monitoring or medication covered under this plan?
• Do I have a co-pay for office visits?
• What is my deductible?
• Will my blood work and ultrasounds have a copay or be applied to my deductible and co-insurance?
• Is there coverage or reimbursement for surrogacy with my plan? [for dads-to-be]
• Are there any exclusions to my plan?

Once you understand your coverage, the next step is to meet with your fertility specialist and determine the path to parenthood that will be best for you.

LGBTQ+ Pathways to Parenthood

For moms-to-be and anyone born with ovaries, there are a few pathways to parenthood including IUI, IVF or reciprocal IVF. Based on your personal health history, fertility workup, and perhaps that of your partner, your doctor will work with you to personalize your family-building journey. 

For dads-to-be and anyone born with testes, your pathway to biological parenthood will require the help of both an egg donor and a surrogate. Your egg donor will contribute their genetics to your future child, and your gestational carrier (surrogate) will carry and deliver the baby.

Note: For trans parents-to-be, there are some special considerations to ensuring you can pursue biological family building. Learn more here.

How to Optimize Your Insurance Coverage

No matter what, LGBTQ+ family building takes time and financial resources — so, how can you best optimize your coverage for your future family? Check out our top tips:

1. Advocate for Yourself with Your HR Department

While it can feel daunting to speak up and push for answers, it's important - not just for you and your future family, but for your fellow employees. Have a conversation with your HR department and come prepared with questions and concerns.

If your company doesn't currently offer any inclusive family-building benefits, ask them why - and provide resources they can explore after your conversation. RESOLVE's employee/employer toolkit is a great place to turn! 

Pro Tip: If you work for a company where straight couples have IVF coverage or a surrogacy reimbursement benefit, you may have more leverage to push for an equitable LGBTQ+ benefit. 

2. Buy Into a Third Party Program

Many larger companies are now offering same-sex couples family-building benefits through an additional third party policy (also sometimes referred to as an insurance rider). We love that companies like Progyny and WINFertility have made this possible. 

3. Use Up Any Remaining Coverage

After you’ve met your deductible for the year, make the most of your coverage and get baseline fertility testing done so you can build your plan with your fertility specialist. Tests like semen analyses, hormone level checks, and even recessive carrier genetic screening may be covered by insurance, even if the rest of your treatment is not.

4. Don't Forget About Open Enrollment

Open enrollment is the time each year when you can switch or upgrade your healthcare insurance plan for the next year. While the general open enrollment period runs from November 1st to December 15th each year, it can be different for each employer and insurance provider, so be sure to reach out to your human resources department to confirm those deadlines.

5. Consider Changing Jobs

While this may seem like an overwhelming option, over 80% of millennials now report that they would switch jobs for better benefits – so you’re not alone if you're considering it! More and more employers are recognizing the value of offering inclusive benefits, so explore the possibilities.

What if I don't have any coverage?

If you don’t have any insurance coverage, all is not lost!

There are many family-building grants available for members of the LGBTQ+ community, as well as organizations like Men Having Babies or Fertility Within Reach, dedicated to providing the advice and support you need.

With increased coverage and continued advocacy, financial support for our families will grow, and LGBTQ+ family-building will no longer have to be a dream realized "at any cost."