Health Insurance and Same Sex Married Couples

Medical coverage for same-sex married couples

For coverage beginning in 2015, an insurance company that offers health coverage to spouses of different sexes must be the same for same-sex spouses. The U.S. Department of the Treasury and the Internal Revenue Service (IRS) ruled that same-sex couples, legally married in jurisdictions that recognize their marriages, will be treated as married for federal tax purposes. The ruling applies regardless of whether the couple lives in a jurisdiction that recognizes same-sex marriage or a jurisdiction that does not recognize same-sex marriage. Other agencies may provide guidance on other federal programs that they administer that are affected by the Code. 

Health Insurance and Same Sex Married Couples

Largely as a result of the federal Defense of Marriage Act of 1996 (DOMA), state law definitions of spouse and marriage may not always be given effect in connection with employee benefit documentation. Nonetheless, federal laws, incuding the Employment Retiree Income Security Act (ERISA), do not prohibit any employer from affirmatively drafting plan documents to recognize same-sex spouses for most benefits.

 

Protection against discrimination in Insurance

While a couple gets married in a jurisdiction with the legal authority to authorize the marriage, the insurance company can not discriminate against them to offer coverage. This means you must provide same-sex spouses the same coverage that offers different-sex spouses.

This is true regardless of the state where:

  • The couple lives
  • The insurance company is located
  • The plan is sold, issued, renewed, or cash

 

Same-sex married couples and reduced insurance costs

The Health Care Marketplace also treats married couples of the same sex couples equal different-sex married when applying for premium tax credits and reduce costs they have to pay in private insurance plans. This is true in all states.

A couple may be eligible for premium tax credits Market plans, provided the taxpayer and his spouse file a joint federal income tax return for the year will get coverage for the market. Married couples must file jointly in order to be eligible for tax credits, regardless of gender.

When you apply for help paying for coverage in the market, they will ask if you are married. If you think you and your spouse file a joint federal income tax return for 2014, select “yes.”

 

Same Sex Couples and Medicare

Social Security is now processing some Medicare enrollments for same-sex spouses, including:

  • Enrollments for free Medicare Part A (Hospital Insurance) for uninsured spouses age 65 or older based on the work history of a current or former spouse
  • Enrollments for people with End Stage Renal Disease (ESRD) based on the work history of a current or former spouse
  • Reductions in Part A premiums based on the work history of a current or former spouse
  • Requests for Special Enrollment Periods based on group health plan coverage from current employment of a same-sex spouse
  • Reductions in late-enrollment penalties based on group health plan coverage from current employment of a same-sex spouse