Married Medicare beneficiaries get
equal access to nursing homes regardless of sexual orientation
HHS change applies to Medicare
Advantage plans; first guidance resulting from Supreme Court’s rejection
of Defense of Marriage Act; Social Security also makes changes
Sept. 3, 2013 - All Medicare
beneficiaries in private Medicare plans will have equal access to
coverage in a nursing home where their spouse lives, regardless of their
sexual orientation, says a news release issued by Health and Human
Services last week. This is the first guidance issued by HHS in response
to the recent Supreme Court ruling, which held 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 last Thursday.
“Today’s 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.”
“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
Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn
“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.”
Security Also Making Changes After Supreme Court Decision
“I am pleased to
announce that Social Security is now processing some retirement
spouse claims for same-sex couples and paying benefits where
they are due, said Carolyn W. Colvin, acting commissioner on
"The recent Supreme Court decision
on Section 3 of the Defense of Marriage Act, made just over a month ago,
helps to ensure that all Americans are treated fairly and equally, with
the dignity and respect they deserve.
She noted that the agency is
working closely with the Department of
She added, "In the coming weeks and months, we will develop and implement
additional policy and processing instructions. We appreciate the
public’s patience as we work through the legal issues to ensure that our
policy is legally sound and clear.
"I encourage individuals who believe they may be
eligible for Social Security benefits to apply now, to protect against
the loss of any potential benefits. We will process claims as soon as
additional instructions become finalized.”
Under current law, Medicare
beneficiaries enrolled in a Medicare Advantage plan are entitled to care
in, among certain other skilled nursing facilities (SNFs), the SNF where
their spouse resides (assuming that they have met the conditions for SNF
coverage in the first place, and the SNF has agreed to the payment
amounts and other terms that apply to a plan network SNF).
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.
This guidance clarifies that this
guarantee of coverage applies equally to all married couples. The
guidance specifically clarifies that this guarantee of coverage applies
equally to couples who are in a legally recognized same-sex marriage,
regardless of where they live, according to the HHS news release.
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