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Medicare regulations updated for same-sex spouses in SNF care


All beneficiaries in private Medicare plans have access to equal coverage of care in a nursing home where their spouse lives, including spouses of the same sex, according to a memo from the U.S. Department of Health and Human Services.

The guidance is the first from HHS in response to a recent ruling by the Supreme Court, which found section 3 of the Defense of Marriage Act to be unconstitutional.

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” HHS Secretary Kathleen Sebelius said in a news release. The 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 beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities, the facility where their spouse resides (assuming 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 might have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or canceling their Medicare Advantage coverage, which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.

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.

The guidance ensures “all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said CMS Administrator Marilyn Tavenner, RN, BSN, MHA. “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.”


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