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 Missouri, same-sex marriage is legal and recognized, in line with the federal law established by the Supreme Court's decision in Obergefell v. Hodges in 2015, which legalized same-sex marriage across all U.S. states and territories. Consequently, health insurance companies in Missouri that provide coverage to opposite-sex spouses are required to offer the same coverage to same-sex spouses. This mandate ensures that same-sex married couples have equal access to health insurance benefits. Additionally, the federal Health Insurance Marketplace® applies the same rules to married same-sex couples as it does to married opposite-sex couples in Missouri and every other state. This means that when applying for premium tax credits and lower out-of-pocket costs on private insurance plans, same-sex married couples are treated identically to their opposite-sex counterparts.