HHS Extends Equal Medicare Advantage Coverage to Same-Sex SNF Residents

Same-sex residents in skilled nursing facilities (SNFs) that are beneficiaries in private Medicare plans will now have access to equal coverage when it comes to care in a nursing home where their spouse lives. 

The Department of Health and Human Services (HHS) issued a memo last week in response to the recent Supreme Court ruling, which found section 3 of the Defense of Marriage Act unconstitutional. 

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius in a statement. “[The] announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

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Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in skilled nursing facilities where their spouse resides. 

Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse, according to Marilynn Tavenner, administrator for the Centers for Medicare & Medicaid Services. 

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Tavenner. “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

The recently issued guidance from HHS specifically clarifies a guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live. 

Written by Jason Oliva

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