Health Care Coverage and DOMA

Health Care Coverage and DOMA – No News Yet

In June of 2013, the Supreme Court overturned DOMA, the Defense of Marriage Act. Prior to this Supreme Court ruling, only heterosexual couples were recognized by federal law as being married. As a result of the ruling, the Treasury Department announced in August that gay and lesbian couples who are married can file joint Federal tax returns. The IRS has indicated that is true even for couples who currently reside in states which don’t recognize same-sex marriage. Thirteen states and the District of Columbia do recognize same-sex marriage.

Does this ruling have an effect on health care coverage?

It should, but no news yet.

What are the implications for the Supreme Court decision regarding DOMA on health care coverage?

Medicare Part A:

Workers who paid Medicare payroll taxes for the required number of years are entitled to premium-free Medicare Part A. Spouses and survivors including widows and divorced women or spouses who didn’t remarry are also eligible for premium-free Part A on a spouse’s account. Part A covers hospital, skilled nursing and a few other important services.

For those who don’t qualify for premium-free Medicare Part A, the current monthly premium is $441. This premium may go up for 2014.
DOMA discriminated against at-home spouses in a same-sex marriage who were not entitled to premium-free Medicare Part A on their spouse’s work record. Given the other changes made at the federal level, one would assume this will change. Again, no word yet on when at-home spouses who are married in same-sex relationships might qualify for premium-free Part A under a spouse’s work record.

Large Group coverage and Medicare Part B:

Medicare Part B covers medical services, doctor visits, surgeries, therapies, outpatient radiology procedure, etc. It is critically important coverage.

Many large employers have covered domestic partners for years. This is extremely generous compared to historical practices among smaller employers. However, this generosity has often backfired against the at-home spouse in a domestic partner or marriage relationship. The problem is that the employer would continue to provide healthcare coverage at age 65 and beyond but because Medicare didn’t recognize the domestic partner relationship as a marriage and did not recognize marriage in the states that allow same-sex marriage, the domestic partner was not provided a Special Enrollment Period for Medicare Part B.

One can enroll in Medicare Part B around one’s 65th birthday in what is called the Initial Enrollment Period. A Special Enrollment Period only applies to workers and dependent spouses who have active, large group coverage beyond age 65. If you are not eligible for a Special Enrollment Period, then you may enroll in Medicare Part B during a General Enrollment Period which is the first quarter of every year for an effective date the following July 1st. Those who enroll during the General Enrollment Period after age 66 pay lifetime premium penalties and many face a gap in coverage. The General Enrollment Period should be avoided and only considered a method of last resort to enroll in Medicare Part B.
Presumably this will change, but same-sex couples should understand this important issue because no change in policy has been reported as of yet. Ironically, until government policy changes, the generosity of the large employer can ultimately hurt an at-home spouse in a domestic partner or same-sex marriage relationship.