Becoming a parent as an LGBTQ+ person can feel like a full-time job in paperwork, patience, and persistence. Between insurance coverage that wasn’t written with you in mind, forms that still assume every family has a “mother” and a “father,” and providers who might not fully get your story—it’s a lot.
You deserve to grow your family without feeling like you have to fight for it. But the truth is, many queer parents still do. Here’s how to go in prepared, protected, and maybe even a little less frustrated along the way.
No Assurance of Insurance
Let’s start with the not-so-fun part: coverage.
Right now, only 21 states require some level of insurance coverage for fertility treatments. But here’s the kicker—most of those laws were written for heterosexual couples, long before “two moms” or “two dads” or “a single queer parent by choice” were seen as part of the fertility conversation.
So when insurance policies say they’ll cover “infertility,” they often define it as a year of trying to conceive through sex with a man. You can imagine how that definition doesn’t exactly fit everyone.
A few bright spots:
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Six states + D.C. specifically include LGBTQ+ individuals and couples in their fertility coverage.
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Only four + D.C. extend that coverage to Medicaid.
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Others offer “partial” coverage, or allow employers to opt in voluntarily.
It’s confusing. It’s uneven. And it’s incredibly unfair. But knowing where your state stands is a crucial first step to advocating for yourself (and avoiding surprise bills that feel like a gut punch).
If you’re ever unsure, call your insurance provider and ask, “How do you define infertility?” and “Does your plan cover assisted reproductive technology for LGBTQ+ individuals?” Take notes. Ask for a written summary. You deserve clear answers.
What’s Actually Covered?
Even when you do have fertility coverage, what’s included can be… selective.
Here’s a quick breakdown of what most insurance plans may cover, and what they usually don’t:
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IVF (In Vitro Fertilization): The most expensive option, and not always included. Some states cover it; others require that you’ve used your own egg and sperm (which excludes most queer couples).
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IUI (Intrauterine Insemination): Often considered a “basic” fertility treatment and more likely to be covered.
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ICI (Intracervical Insemination): Rarely covered, but can often be done safely and affordably at home.
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Office Visits and Medications: These are generally included if you’re seeing a reproductive endocrinologist.
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Fertility Preservation: Coverage for egg or sperm freezing is often limited to “medical necessity” (like before cancer treatment). Trans folks may or may not qualify under those definitions, depending on the plan.
The bottom line: coverage isn’t guaranteed, but knowledge is power. The more you understand what’s not included, the more control you have over planning your path forward.
Protecting Your Family with Paperwork
It’s not romantic. It’s not fun. But it’s necessary.
Even if you’re married, even if your name is on the birth certificate, you still need legal protection. Family law hasn’t caught up with family reality yet, and for queer parents, that means double-checking every “what if.”
Here are a few key steps:
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Second-Parent Adoption: This is the gold standard for legal security, even if you’re married. It officially recognizes the non-biological parent as a legal parent.
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Donor or Surrogacy Agreements: If you’re using a known donor or surrogate, formalize those arrangements with an attorney. It keeps everyone protected and relationships intact.
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Birth Certificates: They’re helpful, but not foolproof. Some states will still challenge a non-bio parent’s rights without an adoption order.
Find a lawyer who specializes in LGBTQ+ family law; it’s worth every penny. It’s not just about the paperwork; it’s about protecting your family’s future.
Breaking Through Barriers to Care
Even before you reach the legal or insurance hurdles, there’s another layer many queer families face: the people part.
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Lack of Cultural Competency: Some healthcare providers still stumble over pronouns, relationship language, or the basic concept of how queer families form. It’s exhausting to educate the person you’re paying for care.
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Discrimination (Subtle or Not): From unnecessary psychological evaluations to “policy restrictions,” bias can sneak into the process under the guise of “medical necessity.”
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Legal Gaps: If you’re a non-biological parent, you may find yourself excluded from medical decisions—especially in states with outdated laws.
These realities are frustrating, but they’re not your fault. And the good news? More clinics, midwives, and OB-GYNs are becoming explicitly LGBTQ+-inclusive. Seek them out. Ask the awkward questions up front. You deserve a care team that sees your family as valid.
Taking Back Control of Your Fertility Journey
Queer families have always built families creatively, courageously, and against the odds. The systems may not be designed for you, but that doesn’t mean they get to define you.
You are not powerless. Every question you ask, every paper you sign, every door you insist on walking through is part of how you’re making space—for your family, and for the ones who come after you.
Love doesn’t need permission. But sometimes, unfortunately, it needs documentation.
And you’re strong enough to handle both.
With Love,
Dr. Jenn
