Some Same-Sex Couples Denied Family Policies On Insurance Marketplaces
By Michelle Andrews
Feb 11, 2014 - Kaiser Health News
Carl Bechdel and Dan Miller started looking for a family plan on the
Pennsylvania health insurance marketplace last fall. After submitting their
application for a bronze-level plan to Highmark Blue Shield in early December,
they became concerned when the end of the month approached and they hadnft heard
from the insurer. Bechdel called customer service and finally learned the
reason: The company doesnft offer family coverage to same-sex couples.
The Highmark employee explained that the company would sell each of them an
individual policy and that their costs would be no different than if they bought
a family plan. But that was small comfort for the Harrisburg couple, who were
married in the District of Columbia in 2012.
gItfs really the disrespect of being treated differently,h says Bechdel, 60.
Despite the Justice Department announcement on Monday giving same-sex
married couples equal recognition in federal courthouses, prisons and other DOJ
programs, inconsistency in the treatment of same-sex married couples under the
health law remains, leading to confusion and dismay in some cases, experts say.
On the one hand, federal rules say that legally married same-sex couples should
be treated the same as opposite-sex couples when it comes to determining
eligibility for premium tax credits and cost-sharing subsidies that reduce the
cost of marketplace plans. That guidance was released last fall after the Supreme
Court struck down a key section of the federal Defense of Marriage Act,
which defined marriage as being between members of the opposite sex.
But when it comes to defining gfamilyh for health insurance purposes, therefs
no clear federal definition; the decision is left up to the states. Moreover, if
state law doesnft spell out what gfamilyh or gspouseh means for insurance
purposes, insurers generally have flexibility to make those determinations
themselves.
gCMS is aware that same-sex married couples in some states are experiencing
issues in obtaining family plans and is looking into ways to address this issue
for the 2015 plan year,h says Aaron Albright, a spokesperson for the Centers for
Medicare & Medicaid Services.
If a married couple buys two individual policies rather than a family plan on
the state marketplace, neither their premium nor subsidy amounts should be
negatively affected, say experts. The family premium would be the sum of the two
individual premiums, and the subsidy amounts would be divvied up between the two
plans.
Same-sex married couples who live in one of the 16 states or the District of Columbia that recognize
same-sex marriages shouldnft have trouble buying a family plan, say experts.
Highmark, which offers plans in West Virginia, Delaware and Pennsylvania,
determines whether to offer same-sex married couples family plans based on state
same-sex marriage laws, said Kristin Ash, a spokeswoman for the company, in an
email. Couples who live in Delaware, where same-sex marriage is recognized, can
buy a single family policy, while couples in the other two states, where such
marriages are not recognized, canft. Ash says the company is evaluating
this policy for future plans.
Blue Cross Blue Shield of North Carolina has already done so. The company had
initially planned to postpone offering family coverage to domestic partners and
same-sex married couples until 2015 while it dealt with technology
requirements related to the health law.
But after the local press, advocates and couples whose insurance had been
cancelled drew attention to the insurerfs stance, Brad Wilson, the companyfs
CEO, announced in January that Blue Cross Blue Shield Of North Carolina worked
with CMS and the state department of insurance to make family coverage available to same-sex married couples
and domestic partners in the individual and small group markets this year.
gWe should have more thoughtfully considered this decision, with full
appreciation of the impact it would have on same-sex married couples and
domestic partners,h said Wilson in his statement. gWefre sorry we failed to do
so.h
Thomas Hafke, and Chad Higby are pleased with the outcome. The Aberdeen,
N.C., couple was married in the District of Columbia in 2012. They were notified
by BCBSNC that their silver-level plan was cancelled shortly after they bought
it.
gIf there was another company I could go with I would have, but therefs no
other option in our county,h says Hafke, 29. gThem calling and apologizing
helped a little bit.h
Some experts say the lack of a clear definition of family for coverage
purposes in the law is troubling. After all, they point out, the health law explicitly prohibits discrimination based on sexual
orientation or gender identity.
gAt what point does it become discrimination?h asks Katie Keith, director of
research at the Trimpa Group, a consulting group that works with lesbian, gay,
bisexual and transgender advocacy organizations. gNow you have these health
plans saying that heterosexual couples can be married and get family plans but
that same-sex married couples canft.h