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
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.
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.
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.
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!
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:
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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.
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.
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.
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.
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.
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:
Feeling overwhelmed? Here are some ways to be more effective:
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Before the open enrollment period begins, check to see if you've met the deductible on your current insurance plan. If you're close to or have already met your deductible, your insurance will cover a greater portion of your medical expenses for the remainder of the year.
Not only is this an opportunity to complete important preliminary fertility and wellness assessments - it may even help you achieve your goals sooner! While some of these next steps may be covered by your current healthcare plan, it's important to confirm coverage with both your insurance provider and the financial counselor at your fertility clinic to reduce the chance of any surprise medical bills.
Unsure of which steps you can take to maximize your current insurance coverage? Reach out to your insurance provider for specific guidance.
Certain fertility and wellness assessments are often covered by insurance, making it worthwhile to explore scheduling and completing them before December 31st.
Consider booking an initial consultation with a fertility specialist (reproductive endocrinologist), as well as an ultrasound to assess uterine or fallopian tube health, an evaluation of your egg reserve, and baseline fertility blood work.
Consider booking an initial consultation with a fertility specialist, a physical exam, semen analysis, and genetic carrier screening. Blood work may also be performed in some cases.
Particularly if you've already undergone surgical or hormonal transitions, it's crucial to have an open and honest conversation with your reproductive endocrinologist. Discussing your medical history and family-building goals will enable your doctor to develop a personalized plan tailored to your needs.
The bottom line? Being proactive now can yield significant benefits in the long run.
By clarifying your current insurance benefits and completing preliminary diagnostic testing, you'll not only gain a deeper understanding of your fertility but also establish a strong foundation with your fertility specialist.
This preparation sets the stage for a smoother and more efficient process, potentially helping you achieve your parenthood goals sooner. Many fertility testing results remain valid for six months to a year, providing you with valuable insights into your reproductive health.
At Illume Fertility, we understand the importance of clarity and support when it comes to making decisions about family building. After your initial consultation, you'll be connected with a financial counselor who will help you navigate your benefits, provide guidance on managing the costs of family building, and connect you with valuable resources specifically tailored for LGBTQ+ families.
Embarking on any path to parenthood is an exciting and transformative journey. For LGBTQ+ parents-to-be, there are often some extra hurdles to jump, which means having all the information in front of you is even more important.
By taking proactive steps to understand your insurance coverage, explore financial resources, and plan strategically, you can empower yourself to make informed decisions and navigate the complexities of LGBTQ+ family building with confidence.
Remember, you're not alone on this journey! There are many organizations, advocates, and resources available to support you every step of the way.