CMS equalizes coverage for same-sex couples, HIV/AIDS patients

The Obama administration has strengthened health insurance protections for same-sex couples and HIV/AIDS patients.

Health insurers offering nongrandfathered plans in the group or individual market must cover same-sex spouses under the same terms and conditions offered to opposite-sex spouses, according to an updated guidance on discrimination.  

In particular, CMS said insurers offering spousal coverage to heterosexual couples also must provide that benefit to same-sex couples who were legally married in a state that recognizes same-sex marriage--regardless of the jurisdiction in which the policy is offered, renewed or where the policyholders live.

To account for insurers that may not have understood the prohibition against discrimination based on sexual orientation when designing 2014 policies, full compliance with the guidance won't start until Jan. 1, 2015.

The same-sex coverage requirement applies to qualified health plans offered through health insurance exchanges. Grandfathered and Medicaid plans do not have to offer coverage to same-sex spouses, although the Obama administration urges state Medicaid programs to do so, the AP noted.

The Obama administration also issued new rule that allows third-party funds from the Ryan White program to pay premiums for HIV/AIDS patients, the Associated Press reported.

The issue arose after Blue Cross Blue Shield of Louisiana denied checks from a federal program that helps consumers with HIV/AIDS pay for medications and insurance premiums. Blue Cross denied targeting consumers with HIV/AIDS and said it rejects third-party premium payments to avoid potential fraud, FierceHealthPayer previously reported.

Back in November 2103, the U.S. Department of Health & Human Services encouraged insurers to reject  third-party payments, claiming they could distort the insurance risk pool and create an uneven marketplace.

The Affordable Care Act's banning pre-existing condition exclusions and removal of payment caps could remove insurance barriers to quality healthcare faced by HIV/AIDS patients and the lesbian, gay, bisexual and transgender community.

For more:
- here's the guidance (.pdf)
- check out the AP article

Suggested Articles

To reduce readmissions and create greater operational and cost efficiencies for providers and payers, we must rethink how we deliver and manage care.

Outpatient specialty drugs can be a lucrative income source for not-for-profit hospitals, but Washington presents some risks, Moody's says.

The growing role of data in our lives raises important questions about data access and ownership. Who rightfully owns the data?