On March 14, the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Oversight issued guidance requiring health insurance companies that provide spousal coverage to married opposite-sex couples to offer the same benefits to legally married same-sex couples.

The release, considered a clarification of existing law rather than new law, stated that "a health insurance issuer offering non-grandfathered group or individual health insurance coverage cannot employ marketing practices or benefit designs that discriminate on the basis of certain specified factors. One such factor is an individual’s sexual orientation." Failing to offer coverage for a same-sex spouse when coverage is offered for an opposite-sex spouse, therefore, would be considered discrimination.

Insurers will be required to follow the guidance for plan or policy years beginning on or after January 1, 2015, but "are encouraged to implement this clarification for the 2014 coverage year." The requirement will apply to health plans sold both on and off the health insurance exchanges created under the Affordable Care Act.

Recent reports of same-sex couples being denied family coverage in North Carolina, Pennsylvania and Ohio may have prompted the clarification. The North Carolina decision was later reversed.