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

The Affordable Care Act (ACA) and other federal policies provide protections for LGBT individuals and their families.

Health insurance Marketplaces, which are organizations set up in every state to create more organized and competitive markets for buying coverage, are prohibited from discriminating on the basis of sexual orientation and gender identity. 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, these protections extend to the health benefits provided in the Marketplace plans, which cannot discriminate based on sexual orientation, gender identity, or health status in how they design their essential health benefits.

In addition to these Marketplace protections, the ACA prohibits discrimination based on gender identity and sex-stereotyping (which in some cases may include sexual orientation) in all health programs that receive federal funding, such as Medicaid and Medicare, among other programs.

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 and What They Mean for Your Insurance Options if you are Legally Married to a Same-Sex Partner:

Beyond the protections under the ACA, the Supreme Court’s June 2013 ruling (overturning part of the Defense of Marriage Act (DOMA) in United States v. Windsor) and subsequent June 2015 ruling (in Obergefell v. Hodges that same-sex couples have the right to marry in all states) mean 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, legally married couples, including same-sex couples, must file a joint tax return to gain access to these tax credits. If you are not legally 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.  However, there remains some question about whether private employers can legally limit spousal coverage to opposite-sex spouses only, many experts believe that an employer who does so would likely found to be in violation of federal Civil Rights law.

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