New Medicare guidance guarantees that same-sex married couples can live in the same nursing home

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CMS Administrator and Secretary of the Medicare Trustees Marilyn Tavenner
CMS Administrator and Secretary of the Medicare Trustees Marilyn Tavenner

Nursing homes may see more same-gender married couples in the near future in light of federal regulators' first guidance in response to a recent change in the Defense of Marriage Act.

Private Medicare plans must provide coverage so that married couples that are eligible for skilled nursing facility benefits can reside in the same SNF, according to the Department of Health and Human Services. This applies to same-sex as well as opposite-sex couples, according to a memorandum issued yesterday. The guidance applies to all legally married couples, “regardless of where they live.”

“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,” said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services.

The change follows the U.S. Supreme Court decision striking down a key provision of DOMA, which defined marriage as between a man and a woman only. The court ruled on the matter in June. Although it took two months for HHS to issue its first DOMA-related guidance, Secretary Kathleen Sebelius said this is just the “first of many steps” the agency will take to clarify the effects of the ruling.

In Medicare Advantage, member benefits are handled by a private insurer. The government might pay the insurer a lump sum for each beneficiary, to be used for all of that person's eligible medical needs. The idea is that this motivates the insurer to keep beneficiaries healthy. Medicare Advantage cannot charge more than traditional fee-for-service Medicare for skilled nursing facility care.

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