The U.S. Department of Health and Human Services says same-sex spouses of Medicare Advantage members are eligible for coverage for care in skilled nursing facilities, particularly those where their spouse is already receiving care.

The department's guidance notice issued Thursday partially clarifies lingering uncertainty surrounding same-sex spouses' eligibility for federally governed benefits following the U.S. Supreme Court's June ruling overturning Section 3 of the Defense of Marriage Act.

Medicare Advantage beneficiaries whose spouses live in a skilled nursing facility typically were entitled to receive care in the same facility. However, Section 3 of DOMA denied that right to legally wed gay and lesbian couples by prohibiting federal recognition of same-sex marriages.

As a result, same-sex spouses of Medicare Advantage enrollees often were left with the difficult choice of receiving nursing care in a separate facility or dropping their Medicare Advantage plan and paying out of their own pockets for care in the facility of their choice.

“Today, 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,” Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, said in a statement. “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.”

According to the HHS guidance notice, the updated rule regarding Medicare Advantage beneficiaries' nursing care eligibility applies equally to all legally wed same-sex couples, regardless of whether their home state recognizes the validity of their marriages.

%%BREAK%%

Thursday's guidance appears to apply only to same-sex spouses' eligibility for coverage for skilled nursing care and not to their eligibility for overall spousal health care coverage under Medicare Advantage plan.

Prior to the Supreme Court's ruling, Section 3 of DOMA prevented gay and lesbian Medicare Advantage enrollees from extending coverage to their spouses.

HHS Secretary Kathleen Sebelius said the department is “working swiftly” to identify additional changes to its regulations made necessary by the Supreme Court's ruling.

“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,” Ms. Sebelius said in the statement.