IVF coverage in District of Columbia for single and LGBTQ+ patients
District of Columbia's law uses an inclusive definition of infertility: you qualify based on a physician's finding or on being unable to conceive without medical intervention, with no requirement for a period of unprotected heterosexual intercourse. Plans in scope of the law cannot make single or same-sex-partnered patients pay out of pocket for the diagnostic phase that heterosexual couples get covered.
What to ask
- "How does the plan define infertility, and does it apply to me?"
- "Is donor sperm or donor egg purchase covered?" (Most state laws exclude the purchase; some carve-outs cover it.)
- "Are IUI cycles required before IVF, and do self-paid IUIs count?"
Where people get surprised
- Self-funded employer plans (the card usually says 'administered by') are exempt under federal ERISA — appeals go through the plan's internal process and the U.S. Department of Labor, not the state regulator.
- Federal employees on FEHB plans and Maryland/Virginia residents whose plans are issued in MD/VA are not covered — the plan must be issued in DC.
- Medicaid coverage is drugs/diagnosis, not IVF; the IVF benefit is for commercial plans.
- Coverage starts at renewal on/after Jan 1, 2025, not necessarily on Jan 1.
- Surrogate/gestational-carrier costs after embryo transfer are excluded; PGT and long-term storage are plan-specific.