One of the first questions that prospective patients ask when starting to explore their options for LGBTQ+ family-building is, “How much is this all going to cost?” An important question - with a complex answer. Here's what you need to know about finances, insurance, and open enrollment.
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We get it! When it comes to LGBTQ+ fertility and growing a family, there are so many amazing pathways to biological parenthood. Between IUI, IVF and surrogacy, as well as egg or sperm donation, the cost considerations are plenty.
Those numerous possible paths to parenthood can also make it difficult to comprehend the true cost of becoming an LGBTQ+ parent. In addition, these treatments are (unfortunately) not always covered by insurance, making out-of-pocket cost estimates a difficult pill to swallow. And while progress is being made in this arena (like a new definition of "infertility" that no longer excludes single individuals and the LGBTQ+ community), there is still a long way to go.
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?
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plan to use assisted reproductive technology (ART) to build their families, many insurance companies still use outdated criteria that limits access to family-building treatment (such as IVF) to opposite-sex couples only.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.
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:
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.
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.
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:
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.
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.
alaaNote: For trans parents-to-be, there are some special considerations to ensuring you can pursue biological family building. Learn more here.
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:
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.
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.
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.
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.
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.
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."