Ensuring Health Care Coverage for Same Sex Couples

Earlier this month, the Department of Health and Human Services took a big step towards ensuring health care coverage is accessible to same sex couples.

As we know, the Affordable Care Act has provided better and more affordable healthcare insurance to millions of Americans. For many who’ve gone years without adequate coverage, they now have hospital coverage, prescription drug plans, health screenings and much more. But did that transition to same sex couples, especially considering the “moving parts” aspect that remains a year after the Supreme Court ruled parts of DOMA as unconstitutional?

Righting Health Care Coverage

Besides making healthcare coverage available and affordable, there are a few more important “wrongs” that were “righted” with the law’s passage. Now, an applicant cannot be denied coverage for any pre-existing conditions and an applicant may not be charged more if she’s a woman. Insurance companies are prohibited from declining coverage to same sex couples.

This latest announcement, found on the DHS blog, further clarified same sex couples’ coverage. Written by Dr. Matthew Heinz, HHS Director of Provider & LGBT Outreach, lauded the clarification as “one more step toward making health care coverage more accessible and equitable for married same-sex couples.”

What Now?

According to Heinz, there are provisions in place that make it illegal for health insurance companies to discriminate on the basis of certain characteristics, like sexual orientation. He goes on to explain that if an insurance company offers coverage for heterosexual couples, it must also offer to same sex couples the same coverage using the same pricing structures used for opposite sex couples.

The insurance company may not discriminate regardless of where the health insurance policy is “offered, sold, issued, renewed, in effect, or operated, or where the policy holder resides.” It should be noted that this nondiscrimination policy only applies where the same-sex couple’s marriage was validly entered into in a jurisdiction that allows same-sex marriage.

Days after this clarification was announced, the Obama Administration also extended for another month the Pre-Existing Condition Insurance Plan (coverage temporarily available during the transition to the health insurance exchanges for those with pre-existing conditions). It also clarified that health insurance companies that offer health plans under the ACA must accept premium payments from the government in connection with low-income AIDS patient enrollees. According to Dr. Heinz, the expansion of coverage to same-sex couples “will further enhance access to health care for all Americans.”

Centers for Medicare and Medicaid Weigh In

Meanwhile, the Centers for Medicare and Medicaid Services also issued a revised Q&A document. It went a step further and stated, “a health insurer offering non grandfathered group or individual health insurance coverage cannot employ marketing practices or benefit designs that discriminate on the bases of certain specified factors…(including) an individual’s sexual orientation.

This document was concluded with, “We expect issuers to come into full compliance with the regulations as clarified in this guidance no later than for plan or policy years beginning on or after January 1, 2015. We also expect States to begin enforcing the regulations in accordance with this clarification no later than for plan or policy years beginning on or after January 1, 2015.”

Great strides are being made, but for some, there remain problems. If you’re unsure of what this means for you and your family, or if you’re concerned that you won’t qualify because of a co-habitation agreement that doesn’t include a marriage license, give us a call today. We can help you explore those options and help you arrive at a decision that best benefits you and your family.

Suzanne Latimer

Suzanne Latimer

Suzanne graduated cum laude in 1992 and was admitted to practice in Massachusetts that year and New York the following year. After graduation, Suzanne worked for twelve years as a solo practitioner, concentrating in the areas of Family and Matrimonial Law. Since 2005, Suzanne has served as Managing Partner at Latimer/Stroud, LLP.
Suzanne Latimer