Cyr’s bill, S.715, includes several provisions to expand coverage for fertility treatments broadly. While some of those changes may be worth discussing, it’s a difficult time to increase mandates on Massachusetts insurers, given the increasingly unaffordable cost of health insurance.
But one narrow provision of Cyr’s bill — updating the legal definition of infertility — is worth implementing to give queer couples the same benefits as heterosexual couples.
Massachusetts law, written in 1987, defines infertility as being unable to conceive through intercourse for a year or six months, depending on the woman’s age. Typically, it’s only once a couple meets that threshold that they qualify for insurance coverage for fertility-related procedures, although individual insurers can offer more generous policies.
The problem is a single woman or partners in a lesbian couple, for instance, can’t easily meet that definition — leading to an expensive inequity.
During that time period before insurance coverage becomes available, heterosexual couples can try as often as they want to get pregnant and those attempts, obviously, are free. But queer couples often have to pay out of pocket for multiple rounds of intrauterine insemination with donor sperm. Those initial attempts using intrauterine insemination in many cases aren’t covered by insurance. Kate LeBlanc, executive director of the Concord nonprofit AllPaths Family Building, said that typically costs $2,000 to $3,000 per round.
Cyr said he was a sperm donor for friends who paid thousands of dollars out of pocket to have his sperm screened, stored, and tested for diseases.
Queer couples can conceive using donor sperm at home, outside the medical system. But that can carry medical and legal risks if the sperm isn’t tested for diseases, neither party is tested for fertility-related problems, or legal contracts don’t properly ensure the intended parents have parental rights, instead of the sperm donor.
Cyr’s bill would update the definition of infertility in state law to conform with the definition used by the American Society for Reproductive Medicine. It maintains the current definition and adds that someone could also be considered legally infertile based on a physician’s diagnosis or the need for medical intervention to achieve a successful pregnancy either as an individual or with a partner. Cyr’s bill also adds to the association’s definition an individual’s elevated likelihood of passing a serious inheritable genetic or chromosomal abnormality to a child.
These changes would make it easier for not only queer couples and individuals to obtain fertility-related insurance coverage but also for some heterosexual couples. For example, someone with a medical condition that renders them unable to conceive without assistance would no longer have to wait up to a year for coverage.
An analysis of a similar bill in 2023 by the Center for Health Information and Analysis estimated that the added cost to health insurance premiums would be between 10 cents and 23 cents per member per month, although that analysis also included a broader expansion of coverage for medically induced fertility services.
Compared with prior generations, more queer adults today want to have children and are turning to the medical system. A 2019 survey by Family Equality found that among LGBTQ respondents 55 and older, 33 percent are parents or are considering having a child, compared to 77 percent of respondents ages 18 to 35. While older gay and lesbian people sometimes married an opposite-sex partner to conceive, younger respondents were more likely to be considering assisted reproduction or adoption.
The process of trying to have a child, which can be physically and emotionally grueling for anyone, can take a toll on even the best-resourced families, and insurance barriers add to that toll.
Katelyn Nerbonne, a Boston financial technology professional, and her wife had their first child through in vitro fertilization, after several cycles of intrauterine insemination didn’t work. In their case, the procedures were all covered by insurance.
But when they wanted a second child, the insurer insisted Nerbonne’s wife “reprove” her infertility through more intrauterine insemination. They fought for six months, with a lawyer, to get the insurance to cover IVF. “We’re professionals who have strong educations, and we found it incredibly difficult to navigate the system,” Nerbonne said. “My mind is on how do we make this easier for families in the future?”
Alix Quinn, clinical director of Fenway Health’s insemination program, said some of her patients have insurance coverage that covers most of their fertility care. Others don’t have fertility coverage at all or have plans that “require them to jump through a lot of hoops” to get coverage, whether involving bloodwork, invasive testing, or multiple cycles of insemination, which can cost thousands of dollars.
There is growing awareness of insurance inequities. Earlier this month, a US District Court judge in California ordered insurer Aetna to cover fertility treatments for same-sex couples nationwide the same way they do for heterosexual couples. A lesbian couple had challenged Aetna’s policy requiring women without a male partner to undergo multiple rounds of intrauterine insemination before obtaining insurance coverage.
Seven states, including Maine, New York, and New Jersey, already have LGBTQ-inclusive definitions of how to qualify for fertility-related insurance coverage, according to LeBlanc.
Massachusetts has long been a leader in both health insurance coverage and LGBTQ rights. Updating the law to make it easier for more queer couples to have children would be another step forward.
Let’s lower barriers to LGBTQ fertility treatments
