Acting to expand health insurance access for same-sex couples, the Obama administration said Friday that plans offering benefits for heterosexual couples must also provide coverage for married couples who are of the same gender.
The policy, posted online by the Department of Health and Human Services, takes effect next year and applies to plans offered in the health care law's new insurance markets. It also covers many — but not all — individual and employer plans offered outside that marketplace.
The administration acted after gays and lesbians complained that they're not sure how the rules of the new insurance exchanges apply to them — particularly in states that do not recognize same-sex marriage.
The department said it was moving to clarify those rules and make coverage "more accessible and equitable for married same-sex couples." It's part of a government-wide effort to codify the rights of same-sex spouses following the Supreme Court's decision last year striking down the federal Defense of Marriage Act and opening the way for same-sex spouses to receive government benefits.
The new HHS policy says that if an insurance company offers spousal coverage to heterosexual couples, it must also provide that benefit to same-sex couples who were legally married in a jurisdiction that recognizes marriage between people of the same sex.
The administration is urging insurers to voluntarily comply with the same-sex rule right away. It will be a requirement for coverage starting Jan. 1, 2015, or later.
Many large employer plans are already operating under similar rules issued last fall by the Labor Department. These are so-called self-insured plans in which an employer sets aside its own money to cover most of the expected medical costs of workers. Self-insured employers generally hire an insurance company to administer their benefit plan.
The new HHS rules apply instead to plans that are sold directly by insurance companies to individuals and employers, usually small to mid-sized companies.
There are exceptions:
• "Grandfathered" plans that were in existence when the health law passed four years ago and have changed very little since then do not have to offer coverage to same-sex spouses. Those plans, however, represent a dwindling share of the market.
• The new policy does not apply to Medicaid coverage for low-income people. The administration encourages states to offer Medicaid benefits to same-sex spouses, but state authorities have the final say.
Separately, HHS issued another one-month extension for the Pre-Existing Condition Insurance Plan, known as PCIP. Patients in the temporary program will now have until April 30 to find a new policy. PCIP was created as a transitional program for people turned down for coverage because of health problems. The law now requires insurers to take all applicants regardless of their medical history.