Non-traditional Households

Does being lesbian, gay, bisexual, or transgender (LGBT) affect my health insurance coverage and options? What if I am married to my same-sex partner?

You cannot be turned away or charged more for being lesbian, gay, bisexual, or transgendered. You also can’t be denied coverage or charged more because of any pre-existing health condition, such as your HIV status.  Insurers can’t limit how much they’ll spend on your medical care – over a year or over a lifetime.

Under the ACA, health programs that receive federal funding, such as Marketplace plans, Medicaid, and Medicare, among others, cannot discriminate based on sex.  The Biden administration has said it will include protections based on sexual orientation and gender identity under these sex nondiscrimination protections. Details on how this explicitly applies to plans and coverage are forthcoming but the administration has said it will enforce these protections. Notably though, the legal landscape is continuing to evolve, including with respect to the intersection of these protections and religious liberty protections for providers.

There are also other federal policies designed to protect you and your family.  Virtually all hospitals must now allow visitation by a same-sex partner (whether or not you are married) and same-sex partners must be afforded the same treatment as other spouses for long-term care, such as nursing home care under Medicaid.  In addition, same-sex couples (whether or not you are married) now have the same rights as others to name a representative to make medical decisions on a patient’s behalf.

Supreme Court Rulings on LGBT Issues and What They Mean for Your Health Coverage if you are LGBT:

Beyond the protections under the ACA, the Supreme Court’s  June 2015 ruling (in Obergefell v. Hodges) found that same-sex couples have the right to marry in all states, meaning that same-sex marriages are  recognized under federal and state law.  This has implications for the health care Marketplaces as well as for Medicaid and CHIP, Medicare, and coverage through your employer:

Health Care Marketplace: Legally married same-sex couples can apply jointly for tax credits in the Marketplace.  These tax credits help you pay the costs of your health plan.  Tax credits are calculated based on your federal income tax filing, so marketplaces must recognize same-sex marriages and base eligibility on a married couple’s income.  In fact, married couples, including same-sex couples, must file a joint tax return to gain access to these tax credits. If you are not married – if you are in a domestic partnership, a civil union, or another relationship – you may still be able to get these credits but will need to apply for them separately as individuals instead of as a couple; depending on your state Marketplace, you may be able to use your individual credits to buy a family policy rather than two individual policies.

Medicaid and CHIP: All states must recognize same-sex marriages when determining whether or not you meet your state’s income eligibility requirement for Medicaid and CHIP.

Medicare: If you are married to your same-sex partner, you may now qualify for Medicare coverage based on your spouse’s work history.

Health coverage through an employer: All federal employees, federal contractors, members of the military, veterans, and state employees who are legally married to a same-sex partner may now obtain spousal health benefits for their partner. In addition, all health insurance issuers who offer coverage to opposite-sex spouses must also offer coverage to same-sex spouses.

Department of Veterans Affairs:  The VA recognizes same-sex marriages and will extend benefits to same-sex spouses of Veterans, including CHAMPVA health coverage, survivor compensation, and burial benefits

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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