Same-sex marriage refers to lawful marriage between spouses of the same sex. Same-sex marriage is legal and recognized in every U.S. state and the District of Columbia (Washington, D.C.).

As long as a same-sex couple is married in a jurisdiction with legal authority to authorize the marriage, a health insurance company that offers health coverage to opposite-sex spouses must do the same for same-sex spouses.

The federal Health Insurance Marketplace® also treats married same-sex couples the same as married opposite-sex couples in every state when they apply for premium tax credits and lower out-of-pocket costs on private insurance plans.

In Hawaii, same-sex marriage has been legal since December 2, 2013, following the passage of the Hawaii Marriage Equality Act. This law ensures that same-sex couples have the same rights to marry as opposite-sex couples. Consequently, health insurance companies in Hawaii that provide coverage to opposite-sex spouses are required to offer the same coverage to same-sex spouses. This is in line with federal regulations, which mandate that legally married same-sex couples are treated equally to married opposite-sex couples for purposes of federal benefits, including health insurance. The federal Health Insurance Marketplace® applies this standard nationwide, meaning that when same-sex couples who are legally married apply for premium tax credits and lower out-of-pocket costs on private insurance plans, they are treated the same as their opposite-sex counterparts in every state, including Hawaii.