Employer-Based Health Insurance is Impacted by the Recent Decision on Same-Sex Marriage


Last month’s Supreme Court ruling legalizing same-sex marriage across the country make it crystal clear to employers that they must offer exactly the same health benefits to same-sex married couples as heterosexual couples.  According to HealthCare.gov, this is true regardless of the state where:
  • The couple lives
  • The insurance company is located
  • The plan is sold, issued, renewed, or in effect
A Word of Caution for Domestic Partners
Last year, a Kaiser Family Foundation survey reported that only about half of insurance providers allowed same-sex, unmarried domestic partners to claim insurance benefits.  That number could drop even more if health insurance companies decided to drop coverage to domestic partners altogether in light of the new ruling.
Health Insurance Enrollment for Married Couples
If an employer already offered health insurance coverage to married same-sex couples during their most recent open enrollment, an uncovered spouse will need to wait until the next enrollment period to apply.
However, if an employer did NOT offer coverage to same-sex married couples before the recent ruling, the provider may be offering additional time to enroll, treating the ruling as a qualifying event.  United Healthcare, for example, is allowing previously ineligible same-sex spouses until July 31 to retroactively enroll.  It’s important to check the policy of the insurer.  Otherwise, the spouse will have to wait until the next enrollment period.
Important Note About Self-Insured Healthcare Plans
Many large employers offer “self-insured” plans who have more flexibility when it comes to their coverage, including the definition of spouse.  While such plans may currently continue to use a plan-specific definition of spouse, they are opening the floodgates to both federal and state anti-discrimination claims.  Still, it’s important for those with self-insured plans to understand their rights.
The Impact on Medicaid / Medicare
The new ruling also requires each state’s Medicaid program to now recognize all legally wed spouses the same way when determining entitlement to, or eligibility for, Medicare.  Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). The U.S. Social Security Administration works with CMS by enrolling people in Medicare.  According the Medicare.gov, Social Security is now processing some Medicare enrollments for same-sex spouses.  Details can be found here.
The Bottom Line
While same-sex marriage is now legal in the United States of America, when it comes to healthcare, there are still many legal and logistical challenges facing same-sex couples, married or not.  It’s as important as ever to understand your rights and to take action to protect them.
 
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