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 Iowa, same-sex marriage has been legal since a landmark decision by the Iowa Supreme Court in April 2009, which ruled that the state's ban on same-sex marriage was unconstitutional. This decision in Varnum v. Brien made Iowa the third state in the U.S. to legalize same-sex marriage. Following the U.S. Supreme Court's decision in Obergefell v. Hodges in June 2015, same-sex marriage became legal in all 50 states. Consequently, in Iowa, health insurance companies that offer coverage to opposite-sex spouses are required to provide the same coverage to same-sex spouses. This includes private insurance plans, employer-sponsored plans, and the plans offered through the federal Health Insurance Marketplace®. Married same-sex couples in Iowa are entitled to the same benefits, including premium tax credits and lower out-of-pocket costs, as married opposite-sex couples when they apply for health insurance coverage.