Does Insurance Cover LGBTQ+ Family Building? Here's What to Know

The list of companies offering LGBTQ+ inclusive fertility benefits continues to grow, with employers like Starbucks, Amazon, and Microsoft leading the way. But even if you're lucky enough to have coverage, it can still be hard to determine what your insurance policy will (or won't) cover. In this guide, you'll learn the right questions to ask and where to turn for support.

In this article:

• Will insurance cover LGBTQ+ family building?
• The State of LGBTQ+ Fertility Coverage
• Understanding Your Insurance Policy
• Questions to Ask HR About Fertility Benefits
• How to Maximize Your Benefits During Open Enrollment
• Aligning Your Insurance & Family Goals
• Leveraging Your Financial Resources
• Navigating the Absence of Family-Building Coverage
• Financial Grants & Resources for LGBTQ+ Families
• What to Do Before This Year Ends
• Appointments & Fertility Tests to Schedule Now
• Planning for Your Future Family

Will insurance cover LGBTQ+ family building?

The shift towards more employers offering inclusive fertility coverage does mark a positive step in ensuring LGBTQ+ individuals and couples have equitable access to vital family-building resources, such as IVF and surrogacy.

That said, many companies and benefit providers still fall short when it comes to providing equal reimbursement for essential family-building services - and interpreting the complex language of insurance policies can be daunting.

In this guide, we'll share the best steps you can take to better understand your current insurance coverage and how to financially plan for LGBTQ+ family building. By the end, you will feel equipped with the knowledge and tools you need to confidently advocate for yourself, find available resources, and make informed decisions on your path to parenthood.

The State of LGBTQ+ Fertility Coverage 

In October 2023, the American Society for Reproductive Medicine (ASRM) expanded the definition of infertility to include all patients who require medical intervention, such as use of donor gametes (eggs or sperm) or embryos, to conceive as a single parent or with a partner.

Previously, the organization had defined infertility as a condition in which heterosexual couples couldn’t conceive after a year of unprotected intercourse. The group emphasized that the new definition should not "be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation."

Illume's Founder and Medical Director, Dr. Mark Leondires, feels this update is promising for those in the LGBTQ+ community. "It gives us extra ammunition to say, 'Listen, everybody who meets the definition of infertility, whether it’s an opposite-sex couple or same-sex couple or single person, who wants to have a child should have access to fertility services,'" he said. 

Signs of Progress

As of August 2024, a total of 21 states have laws mandating that private insurers cover fertility treatments, but only 15 include at least one cycle of in vitro fertilization (IVF) in that mandate, and only three states inclusively cover LGBTQ+ people.

Fortunately, an increasing number of recent rulings have supported expanded LGBTQ+ fertility coverage, and advocates across the country are actively working to push for additional progress. That pressure is leading to real change.

Aetna recently announced it would be expanding fertility coverage - regardless of the policyholder’s sexual identity or partner status. They were the first insurance carrier to make this change, and will undoubtedly result in other insurers following suit. 

Understanding Your Insurance Policy

If you receive insurance coverage through your employer, it's crucial to engage with your HR department or representative to gain a clear understanding of your plan's coverage and reimbursements for LGBTQ+ family building.

In addition, employees can take proactive steps to advocate for more comprehensive and inclusive insurance coverage at their workplaces. This approach can be empowering, allowing you to take charge of your family-building journey while helping to pave the way for others.

Don't be afraid to advocate for more inclusive policies and protections from your employer. While this conversation might feel daunting, remember - you have a right to know what benefits are available to you!

Questions to Ask HR About Fertility Benefits

When employees use their voices to demand more comprehensive coverage at work, everyone benefits. To guide your conversation and ensure you receive all the information you need to move forward, consider asking the following questions:

• Is there a fertility benefit offered at this company? If the answer is yes, inquire about the specific treatments and testing covered under the benefit. Confirm whether this benefit applies equally to all employees, regardless of gender or sexual orientation.
• Are there any waiting periods or eligibility requirements? Many plans have requirements that must be met before accessing fertility benefits.
• Are there a variety of in-network fertility clinics to choose from? If so, inquire if any of these clinics offer specialized programs or services tailored to the unique needs of the LGBTQ+ community.
• Are reimbursements offered to all employees for procedures that are typically not covered by insurance, such as surrogacy? This question is critical in understanding the extent of financial support available for family-building options beyond traditional fertility treatments.
• Are there any exclusions to our fertility/family-building policies that I should be aware of? It's essential to be aware of any limitations or restrictions within your company's policies that might impact your care.
• What is the maximum lifetime or annual coverage amount for fertility treatments? Having this information helps you avoid unexpected out-of-pocket costs and make the most informed decisions about your family-building journey. 

Just getting started?

Get all the facts about LGBTQ+ family building, including where to begin your journey and what to expect along the way.

How to Maximize Your Benefits During Open Enrollment

While advocating for yourself throughout the year is crucial, open enrollment presents a unique opportunity to make significant changes to your insurance plan. This annual period, which typically occurs from November 1st and December 15th, allows you to evaluate your current coverage and select a plan that best aligns with your goals for the coming year.

Note: While you may have until January 15th to make adjustments, meeting the December 15th deadline ensures that your new coverage takes effect on January 1st.

For individuals who are self-employed or work for small businesses, exploring plans available through the Health Insurance Marketplace or independent insurance companies can be a viable option. If you work for a larger company, open enrollment is an ideal time to carefully assess the plans offered by your employer and choose the one that best suits your needs.

Open enrollment periods can vary from company to company, so we recommend you confirm with your HR department and mark any relevant deadlines on your calendar.

Aligning Your Insurance & Family Goals

Open enrollment provides the perfect opportunity to select an insurance plan that supports your family-building aspirations for the upcoming year. If you're considering biological family building through fertility treatment, opting for a plan with a lower deductible can be advantageous. This ensures that your insurance coverage kicks in sooner, reducing your out-of-pocket expenses.

Additionally, you should use this time to engage in open communication with your employer about the specific fertility or family-building benefits offered under each plan. Inquire about any potential reimbursements for certain costs associated with your chosen path to parenthood.

Many employers are also now offering third-party policies that extend coverage to LGBTQ+ family building, so be sure to explore this option with your HR representative.

Leveraging Your Financial Resources

Even if your company doesn't provide specific coverage for LGBTQ+ family building, there are various financial resources available to help you navigate the costs associated with your journey. These resources can be utilized with support from your employer or independently, and many offer tax benefits to help you save money.

• Flexible Savings Account (FSA): This allows you to set aside pre-tax dollars from your paycheck to cover unreimbursed medical expenses, including certain fertility treatments.
• Health Reimbursement Account (HRA): Funded by employers, HRAs provide employees with funds to pay for qualified medical costs, which may include family-building services.
• Health Savings Account (HSA): Designed for individuals with high-deductible health plans, HSAs allow you to save pre-tax money to cover qualified medical procedures, potentially including fertility treatments.

It's crucial to consult with your employer's benefits administrator or the company issuing the account to confirm that fertility treatment expenses are eligible for coverage under these programs. This helps you create a personalized financial plan that optimizes all available resources.

Navigating the Absence of Family-Building Coverage

In the event that your company doesn't currently offer family-building benefits, try not to be discouraged. Persistence and advocacy do lead to positive change! Continue to engage with your employer, emphasizing the importance of equitable coverage for all employees.

If efforts to secure coverage through your employer are unsuccessful, there are always alternative avenues to explore. Consider seeking financial assistance and other resources from organizations dedicated to supporting LGBTQ+ families, such as Family Equality. 

Additionally, if your primary insurance policy falls short, explore third-party providers like Progyny, which offer expanded coverage for pathways like surrogacy and adoption. Raising this option with your HR department can be a valuable step in securing the coverage you need.

Financial Grants & Resources for LGBTQ+ Families

For many, securing partial or full financial assistance can significantly ease the burden of LGBTQ+ family building. Here are just a few of the grants and resources available: 

1. Family Equality: A comprehensive list of financial assistance resources for LGBTQ+ families pursuing adoption, foster care, or assisted reproductive technologies.
2. Help Us Adopt: Provides grants up to $30,000 to LGBTQ+ couples and individuals pursuing adoption.
3. BabyQuest Foundation: Offers grants for fertility treatments (IUI, IVF, egg donation, surrogacy) to all individuals and couples, regardless of sexual orientation.
4. Cade Foundation: Helps couples by providing several different types of grants to those struggling with infertility. Their LGBTQ+ friendly grants provide up to $10,000 to help with the costs of domestic adoption or fertility treatment.
5. Nest Egg Foundation: Grants of up to $20,000 can be used to pay for IVF only (may include IVF treatment cycle, embryo, egg, or sperm cryopreservation, embryo testing, and cycle medications). 

Tips for Finding & Applying for Grants

Feeling overwhelmed? Here are some ways to be more effective:

• Start early: Research and apply for grants well in advance of your planned family-building journey, as most require time to gather and organize information.
• Be thorough: Pay close attention to eligibility requirements and deadlines! Most have narrow application windows or require you to live in a specific area, for example.
• Tell your story: Craft a compelling personal statement that highlights your unique circumstances and family aspirations.
• Get support: Don't hesitate to reach out to grant organizations, financial advisors, and family-building professionals for guidance throughout the process.

Support for Surrogacy

Explore financial grants, a vetted list of organizations, surrogacy agencies, LGBTQ+ support groups, and other resources.