Aetna Agrees to Landmark Nationwide Settlement: IVF Coverage Extended to Same-Sex Couples

U.S. District Judge Haywood Gilliam Jr. for the Northern District of California approved a preliminary agreement in a class action lawsuit against Aetna last week, mandating the insurer cover fertility treatments such as artificial insemination and in vitro fertilization for same-sex couples nationwide, matching benefits provided to heterosexual couples. This settlement, the first of its kind applying nationally across all Aetna enrollees, is expected to benefit approximately 2.8 million LGBTQ+ members, including 91,000 in California.

The lawsuit stemmed from Aetna's prior policy, which required enrollees to undergo six to 12 months of "unprotected heterosexual sexual intercourse" without conceiving to qualify for fertility benefits, effectively excluding same-sex couples and single individuals. Women without a male partner could access benefits only after six to 12 unsuccessful cycles of artificial insemination, depending on age, a requirement that lawyers argued discriminated against LGBTQ+ people by denying equitable access to costly treatments. Lead plaintiff Mara Berton, a lesbian from California, and her wife June Higginbotham paid $45,000 out of pocket for treatments that heterosexual colleagues with the same plan had covered, highlighting the financial burden known as the "Queer Tax."

Berton faced repeated denials from Aetna despite consulting fertility clinics and opting for donor sperm and artificial insemination; the insurer insisted on 12 rounds before IVF eligibility, far exceeding her doctors' recommendation of four. Higginbotham described the process as "dehumanizing," noting concerns over limited donor sperm matching her Jewish and Native American heritage. Under the settlement, Aetna will pay at least $2 million in damages to qualifying California-based members, with claims due by June 29, 2026; nationwide, the policy aligns with the American Society for Reproductive Medicine definition of infertility, granting immediate access regardless of sexual orientation or partner status.

Aetna spokesperson Phillip Blando stated in an email: "Aetna is committed to equal access to infertility coverage and reproductive health coverage for all its members, and we will continue to strive toward improving access to services for our entire membership." The insurer's updated policy, effective nationwide from September 1, 2024, for many plans and on a rolling basis thereafter, covers intrauterine insemination to evaluate infertility for LGBTQ+ people and single individuals without a reproductive partner.

Alison Tanner, senior litigation counsel for reproductive rights and health at the National Women's Law Center, called the settlement a step toward equality: "We were looking at that as an issue of inequality — that folks who were in same-sex relationships were being treated differently." She hopes it prompts other insurers to follow. Higginbotham echoed this, stating the decision "is such a huge step forward that is really righting a huge wrong," as many LGBTQ+ people delay or forgo parenthood due to uncovered costs.

Sean Tipton, chief advocacy and policy director for the ASRM, criticized prior policies as designed to dissuade access, noting doctors recommend three to four IUI cycles before IVF, and studies show direct IVF can be more cost-effective. The ASRM updated its infertility definition in 2023 to include LGBTQ+ individuals and those without partners, recognizing that reproduction requires two types of gametes regardless of relationship status, which has spurred employer and insurer changes.

This settlement coincides with California's new law, effective January 2026, mandating fertility benefits for state-regulated plans, including same-sex couples and single people—affecting roughly 9 million more residents, though Aetna plans are federally regulated. Advocates view the Aetna case as setting a precedent, potentially influencing other insurers to eliminate orientation-based barriers, advancing reproductive equity for transgender people, nonbinary individuals, and all LGBTQ+ families seeking to build families.