Health Insurance Guide for Same-Sex Couples

WRITTEN BY: Craig Sturgill


The civil rights cases United States v. Windsor and Obergefell v. Hodges struck down the Defense of Marriage Act (DOMA) and marked a huge win for the LGBT community. The court decision means the law recognizes same-sex marriages as equal under the law in all states and the District of Columbia.

These US Supreme Court decisions expand health insurance for same-sex couples. Here is our easy-to-understand health insurance guide for same-sex couples.

Who’s eligible for same-sex benefits?

Health insurance for same-sex couples is available if the employer offers health insurance benefits to opposite-sex spouses.

Children of a same-sex couple are also eligible if the plan covers dependents. A couple in a same-sex marriage may also jointly apply for a health Marketplace plan for tax credits or subsidies.

If your spouse is any of the following, they may apply for same-sex spousal benefits.

  • Federal or state employee
  • Federal contractor
  • Member of the military
  • Veteran

Members of the Veteran Affairs may also receive same-sex spousal health coverage.

The law doesn’t extend to unmarried couples in a same-sex relationship. It also doesn’t apply when you purchase health insurance on your own.

Do employers have to offer same-sex spousal coverage?

Federal law requires employers with fully-insured group health insurance benefits for opposite-sex spouses to offer the same for same-sex spouses.

These requirements don’t extend to self-insured insurance plans. However, the employer may face an Equal Employment Opportunity Commission (EEOC) complaint for discrimination based on sexual orientation.

Regarding same-sex spousal health coverage from the Marketplace, both the state and federally-run Marketplaces must treat same-sex spouses as equal to opposite-sex spouses. Even before Obergefell, the Affordable Care Act (ACA) didn’t restrict same-sex couples from combining their tax credits for family coverage.

Domestic partnerships, civil unions, and health benefits for same-sex couples

Under Federal government law, employers don’t need to provide insurance coverage to domestic partners. A domestic partnership is a relationship between two people of the same or opposite sex who live domestically as a married couple but aren’t legally married.

Domestic partnerships are the creation of Tom Brougham, a California gay rights activist. The work of Brougham and others led to domestic partnerships state-wide for California and other states.

Both heterosexual and LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) couples in these relationships must legally register with the state to be considered a true domestic partnership.

As DOMA isn’t active law, same-sex people previously in a domestic partnership may legally marry. Their legal marriage then entitles them to benefits if a spouse’s employer offers opposite-sex spouses the same benefits.

However, specific states still recognize domestic partnerships, and employers may provide same-sex partner benefits.

The following states recognize domestic partnerships between heterosexual couples and same-sex couples:

If you live in one of these states and have a domestic relationship, you may be eligible for domestic partnership benefits if an employer offers spousal healthcare coverage. However, you should research the qualifications for domestic partnerships.

Civil unions are similar to domestic partnerships and offer unmarried couples legal protections, group healthcare coverage, and other benefits. Today, since Obergefell, only a handful of states have civil unions: Colorado, Hawaii, Illinois, and New Jersey. You may receive spousal health insurance coverage if you’re in a legally-recognized civil union and your state mandates the coverage.

Same-sex couples and Medicare

DOMA’s invalidation also reforms the Medicare policies for same-sex married couples. Married same-sex couples have the same rights as opposite-sex couples. At 65, you’re eligible for Medicare Part A (or hospital insurance) without a monthly premium if you pay payroll taxes and earn 40 work credits.

However, if you don’t meet this requirement, you may use your age 62+ spouse’s work record if they reached 40 credits. To qualify, you must be married for at least a year or divorced after a marriage of 10 or more years.

If your spouse passes away, the marriage must last nine months or more. You can’t remarry and apply for Medicare on your spouse’s income.

You can also delay your Medicare Part B (medical services) without a penalty if you’re on your spouse’s employer’s health insurance. You may qualify for a Special Enrollment Period of up to eight months once that employer insurance ends.

Same-sex couples and Medicaid

All state Medicaid agencies recognize the rights of married same-sex couples as the same as married opposite-sex couples. If you’re in a same-sex marriage, you will have the same rights and requirements for Medicaid.

The law also provides CHIP (Children’s Health Insurance Program) coverage to children of same-sex marriage if they meet eligibility guidelines. States vary by requirements and eligibility, so check your state Medicaid office for more information.


Can you add your girlfriend to your health insurance?

It depends on the state and your employer. You may only add your girlfriend to your health insurance if you’re in a state-recognized domestic partnership and your employer offers domestic partnership benefits.

Can married couples share health insurance?

Yes. Married couples may share health insurance on the health insurance Marketplace. If an employer offers spousal health insurance, both opposite-sex and same-sex couples may share these benefits.

Can I add my boyfriend to my insurance plan?

No. The only exception is if you’re in a domestic partnership in certain states and your employer offers domestic partner benefits.

Can I add my partner to my health insurance plan?

Yes. If you’re married and your employer-provided health insurance plan allows spousal coverage. You can add your spouse to your plan for family health insurance through the Marketplace.

What are the benefits of a domestic partner health insurance plan?

If you’re in a domestic partner health insurance plan, you can receive coverage on your partner’s plan. You benefit from this if your employer-provided health insurance plan is too expensive, your employer doesn’t offer healthcare, or you’re self-employed. However, domestic partnership benefits are limited.

Can same-sex couples share insurance?

Yes. Same-sex couples can share health insurance with a family plan on the Marketplace. They also share health insurance if their employer offers health insurance to spouses.

Can my insurance cover my spouse?

Your spouse is covered by your employer-provided health insurance or your family plan if the insurance company offers spousal benefits.

Can my spouse and I share the same insurance?

You and your spouse can share insurance in a family plan on the Marketplace or through a private insurer. You may have spousal insurance if one of your employers offers it.

What if my spouse is not a U.S. citizen?

The answer varies. Most group health insurance plans require a Social Security Number (SSN), so it’s often impossible to add a non-citizen. However, if your spouse is lawfully present, and has a Green card or Visa, they may be on your health plan through the Marketplace.

Get Health Insurance for Your Family

Thanks to landmark court cases, federal and state governments view married same-sex couples as equal to opposite-sex couples. Same-sex couples enjoy the same access to health insurance if they shop in the Marketplace. You may also find a family plan off the Marketplace. If you want a new health insurance plan for you and your spouse, use our online tool to compare various rates.