Healthcare Coverage Options for Same-Sex Couples


For the longest time, same-sex couples who were, for all practical purposes, “married” as a result of their lifelong commitment to each other were nonetheless unable to receive all the benefits that legally married heterosexual couples received, such as healthcare benefits.

Little by little and state by state, same-sex couples slowly obtained the rights that heterosexual married couples had long enjoyed. Finally, in June of 2015, the United States Supreme Court legalized same-sex marriage nationwide in the landmark case Obergefell v. Hodges. Since that decision, the landscape for same-sex couples has drastically changed. One way things have changed is within the context of healthcare benefits.

Healthcare Coverage Options for Married Same-Sex Couples

Since the passage of the Obergefell Supreme Court decision, same-sex married couples must be treated like any other married couple with respect to health care coverage offerings. This means that if an employer, state healthcare exchange or insurance company offers a particular insurance plan to heterosexual married couples, they must offer it to all same-sex married couples as well.

However, if the same-sex couple is not married, things get a little more complicated.

Healthcare Coverage Options for Same-Sex Couples Who Are Not Married

Healthcare coverage options available to unmarried same-sex couples will depend largely on who is offering the health insurance. If the couple is looking to purchase health insurance directly from an insurance company or through a state health insurance exchange, they will not be treated as if they’re married. This means they will need to obtain health insurance on their own or from an employer that offers domestic partner health care benefits (we’ll get to this in a minute).

If a same-sex couple is looking to gain insurance coverage from one of their employers, the details of the employer’s healthcare offerings and the state in which it is offered will determine the coverage available. We’ll look at two hypothetical situations to explain how things might play out.

Employer Healthcare Coverage Variations

In the first hypothetical, Robert and Charles are an unmarried same-sex couple. Robert’s employer doesn’t provide healthcare benefits, but Charles’ employer does. More specifically, Charles’ employer offers domestic partnership health care coverage to both heterosexual and same-sex couples. This means Charles can get insurance coverage for himself and Robert.

In the second hypothetical, the facts are the same as the first, except Charles’ employer doesn’t offer domestic partnership health care coverage to employees. Instead, Charles’ employer offers health insurance where only married employees can obtain coverage for their spouse. In this situation, only Charles will be able to obtain health insurance coverage from his employer

As a side note, employers are not required to offer health insurance to employees. But if the employer chooses to provide this benefit, it must do so in compliance with state and federal laws. This means that as a general rule, whatever the employer offers to one group of employees, such as unmarried heterosexual couples, it must also offer to all other employees, such as unmarried same-sex couples.

State Insurance Law Variations

Many states do not have insurance laws that require employers to provide domestic partnership health insurance coverage to employees. In the situation where a state’s insurance laws require employers to provide domestic partnership health insurance benefits, employers can get around this requirement by offering self-insured plans to employees.

Self-insured plans are health care plans owned by the employer, not by an insurance company. In these plans, employers are not subject to state insurance laws and can decide on their own who is eligible for their insurance plan. However, if an employer wants to offer certain benefits only to heterosexual couples and not same-sex couples, the employer is at risk of violating anti-discrimination laws.

Curtis Lee
This article is written by Curtis Lee.

Want to have a happier, healthier marriage?

If you feel disconnected or frustrated about the state of your marriage but want to avoid separation and/or divorce, the course meant for married couples is an excellent resource to help you overcome the most challenging aspects of being married.

Take Course