IVF coverage in Maine for single and LGBTQ+ patients
Maine'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.
- Retrieval limit: 4 completed egg retrievals per lifetime (a retrieval counts even if no eggs are obtained).
- Carriers may exclude IVF for patients who have not tried less-expensive treatment where appropriate — expect an IUI step for unexplained infertility.
- Non-medical donor and surrogacy costs (agency fees, compensation) and reversal of sterilization are excluded.
- MaineCare (Medicaid) does not cover IVF.
- Rule 865 contains a clause allowing IVF/GIFT/ZIFT/FET to be 'limited to two lifetime cycles' whose interaction with unlimited transfers is unclear — ask your carrier how it counts cycles.