HHS to Process Medicare Requests for Eligible Recipients in Same-Sex Marriages

On April 3, 2014, HHS introduced its new policy of allowing the Social Security Administration (SSA) to process requests under Medicare Part A and Part B special enrollment periods as well as for reductions in Part B and premium Part A late enrollment penalties for qualifying individuals in same sex marriages. According to the announcement, HHS is enacting this policy change due to the recent Supreme Court decision in U.S. v Windsor, which found that the Defense of Marriage Act (DOMA) (P.L. 104-199) could not prevent the Medicare administration from recognizing same-sex marriages for the purposes of determining eligibility for the federal program. The FDA also released a guidance on this issue today clarifying the FDA’s interpretation of the terms “spouse” and “family” in light of Windsor.

Enrollments

Enrollment rights under Medicare Part A and Part B often depend on a spouse’s status or, more specifically, on whether an individual was previously covered under a spouse’s plan. This status also has an effect on whether an individual qualifies for a special enrollment period or a general enrollment period. Qualifying individuals in same-sex marriages will now be able to use a same-sex spouses’ status for these enrollment requirements. For instance, now the SSA is able to process requests for special enrollment periods for individuals with group health plan coverage that is based on the current employment of a same-sex spouse. For a complete explanation of the new processing policies for eligible individuals in same-sex marriages, visit the Medicare.gov webpage on “Important information for individuals in same-sex marriage.”

Requests on Hold

For individuals with enrollment requests on hold, CMS has asked them to pay their medical bills out of pocket, and when additional policies are finalized, the request will be approved. Once approved, the individual or their health care provider can submit Medicare claims for payment after the date the coverage starts.

Windsor

The Supreme Court struck down section three of DOMA as unconstitutional in Windsor. As a result, Medicare is no longer prevented from recognizing the rights of individuals in same-sex marriage. In particular, this decision allows Medicare to take same-sex marriage status into consideration when determining an individual’s eligibility for certain Medicare benefits and qualifications for special enrollment periods. In its draft guidance, the FDA also announced its intention to interpret same-sex marriages in accordance with the Windsor decision.