Insurers Could Be Covering Same-Sex Partners, Spouses on the Exchange

Mar 18, 2014

Kim Sanwald and Valerie Lane getting married in San Francisco
Credit Brian Helder

Last November, Kim Sanwald and Valerie Lane were married at city hall in San Francisco, California. When they got back, their health insurance company didn’t recognize them as a couple. So, a few months ago, Sanwald went on the health insurance exchange to find something better.

At first none of the companies they called said they offered same sex plans. But after hours on the phone, they got insured through Priority Health. 

Credit AP Images

“I said I don’t understand on a government health program—through the federal government—that you’ve enrolled in, that you can deny benefits to a legally married gay couple," says Sanwald.

"And she put me on hold again. And she said ‘Well, apparently because you’re legally married, we can.”

Sanwald says, unlike unmarried gay and lesbian couples, she and her spouse were lucky. But Sanwald wonders why it was so difficult for them to get insurance?

After all, the Defense of Marriage Act was struck down just last year—allowing same sex married couples certain freedoms such as filing jointly on federal tax returns.

“We’re a family and we’re a legal family. And it was just very disappointing and again I don’t understand how they can get away with it,” Sanwald says.

Kellen Baker is the associate director of the LGBT Research and Communications Project at the Center for American Progress—a public policy think tank known for their work with the Obama and Clinton administrations.

Baker says nothing in the law says state providers have to offer same sex plans on the exchange. But nothing says they can’t.

“This is not something that some of the insurers have run up against before," he says. "The fact that they’re going to have a lot more couples getting into the market wanting to purchase coverage.”

Dave Waymire is the spokesperson for the Michigan Association of Health Plans. He says, while insurers might be able to offer same sex plans legally, most companies are choosing not to.

“I’m not sure I would say by law they cannot, but I would say by policy and in following the current state law, it’s our belief that most are not,” he says. “I think most companies are concerned about following the current laws of the state.”

Helen Stojic, spokesperson for Blue Cross Blue Shield of Michigan. The insurer boasts the largest network in the state. Stojic says Blue Cross sells domestic partner riders to large corporations that want to offer same sex coverage to their employees. And Stojic says it was one of the first insurance companies to do so.

But on the exchange, she says Blue Cross only offers individual plans for lesbian and gay partners.

“We’re planning to have people sign up on two different contracts." says Stojic. "And the premium’s the same. The deductible’s the same. The out of pocket costs are the same whether you’re on a same contract or on two separate contracts, the way that the government has set up the health plan structure.”

When asked how Blue Cross Blue Shield of Michigan defines "family," Stojic says they comply with Michigan law. The same-sex marriage ban was approved by voters in 2004.

Dave Waymire says, as you would expect, same-sex couples who apply separately will likely pay more.

“There may be some subsidies that are available and some lower priced premiums that are available to people in a family basis. That’s very often the case, not always," says Waymire. "So they may be missing out on that opportunity.”

Kellen Baker says the Affordable Care Act and the DOMA decision have caused a lot of confusion in states like Michigan. How much of these new federal benefits apply to states that have banned same sex marriage? Baker says as we move forward with Obamacare, federal officials need to make this clear.

“The regulations that insurers are operating right now prohibit discrimination by anyone involved in the marketplaces on the basis of sexual orientation or for that matter gender identity. What exactly sexual orientation non-discrimination protections mean was really understood before the Defense of Marriage Act Ruling. So we do think it’s imperative that the administration take a look at what it is requiring of the insurers that are participating in these marketplaces with these protections. And making sure that legally married same-sex couples to access the same coverage as different sex married couples.”

Baker says eventually Michigan and other states will have to catch on. Just last week, the U.S. Department of Health and Human Services announced that any insurance company covering married opposite-sex couples will have to cover married same-sex couples no matter where they live—including Michigan.