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Wedding bells are ringing for fewer people these days, with more couples simply cohabitating instead. That raises an important question for millions of men and women about health insurance coverage and if domestic partners are covered.

As marriage equality has evolved over the past few decades, so has the health insurance industry, with many insurers offering coverage for domestic partners.

In 2019, the share of U.S. adults ages 25 to 54 who were married was just 53%, down sharply from 67% in 1990, according to Pew Research Center analysis released in October 2021. During that same period, the share of adults cohabiting more than doubled, from 4% to 9%.

The U.S. also saw a record high of people who were under 40 and unmarried in 2021. This is the most recent data provided by Pew Research Center.

The health insurance marketplace also offers domestic partnership benefits.

What is a domestic partnership? 

A domestic partnership is when two people live together and share their domestic life as if married — however, they’re not married or joined by a civil union, says Tracy Burns, CEO of Northeast HR Association (NEHRA). 

Domestic health insurance plan

“A domestic partnership is very similar to marriage. It can apply to couples who are not married but live together,” Burns says. “Domestic partnerships provide some legal benefits that married couples enjoy. In some states, domestic partnership is also known as a civil union.”

Some benefits domestic partners receive include: 

  • The ability to add a domestic partner to your health insurance coverage
  • The ability to adopt your partner’s child

If your employer offers health insurance coverage for domestic partners, you’ll likely need to sign an affidavit. You’ll need to confirm that:

  • You’ve lived together for at least six months
  • You’re both 18 or older
  • You share a close personal relationship and are responsible for each other’s common welfare
  • You’re exclusive
  • You aren’t married to anyone else
  • You share the same regular and permanent residence with the intent to continue doing so indefinitely
  • You’re jointly financially responsible for “basic living expenses,” defined as the cost of basic food, shelter, and other expenses
  • You were mentally competent to consent to the contract when the domestic partnership began

No federal laws require employers to include domestic partners in their benefits plans.

What is the difference between domestic partnership and marriage? 

Domestic partners can receive the same health insurance as married employees.

“Domestic partner health insurance is when an insurance contract extends the definition of spouse to recognize domestic partners,” Burns says. “As a result, the health insurance benefits may be extended to the unmarried partner and their children.”

Couples of the same sex, as well as those of the opposite sex, can share insurance under domestic partnership insurance coverage just as a married couple would, Burns says. The biggest benefit of this arrangement is a reduced insurance rate and the ability to be eligible for the employee benefits package, she adds.

Burns suggests you ask your insurance company about your options.

“Ask your benefits plan administrator to find out the specifics and make your formal request so that your partner may be added as soon as possible,” she says. “Most employer health plans will allow the addition of a domestic partner if the plan includes this kind of coverage.”

Burns suggests contacting your HR person or the insurance company directly and asking if you can insure your domestic partner on your employee health insurance plan. If the answer is yes, find out what steps you need to take to get started. 

“If your employer’s health insurance plan does not provide domestic partner insurance, you can check with a private company,” Burns says. 

Do you have to be married to be on the same health insurance?

Not necessarily. If your relationship qualifies as a domestic partnership — and if your company extends health benefits to domestic partners — you might be eligible for health insurance coverage under your partner’s plan.

Who qualifies as a domestic partner for health insurance?

There is no hard-and-fast rule for who qualifies as a domestic partner for health insurance, and the definition may vary from company to company.

The Society for Human Resource Management urges each company to develop a clear definition of exactly who qualifies as a “domestic partner” for health insurance purposes. SHRM also emphasizes the importance of crafting this definition in a way that meets the legal definitions established by the state in which the employer resides.

Can I add my boyfriend to my health insurance?

Employees typically can’t add a boyfriend or girlfriend to their health insurance. 

“Normally, to obtain coverage under an employer’s plan, a person would need to meet the definition in the benefit plan document for the spouse or domestic partner or dependent,” Lee says. 

She adds that in her experience, boyfriends and girlfriends don’t meet any of the definitions to obtain coverage. Employees should check with their company benefits administrator for more information.

Can my fiancé be on my health insurance?

It depends. If a couple lives apart before they marry, they are typically not eligible for domestic partnership benefits. However, if they are in an established and registered domestic partnership prior to getting married or meet other eligibility criteria, they may qualify for benefits during the engagement period.

What states recognize domestic partnerships?

A growing number of states now make legal rights available to non-married partners in same-sex relationships. These are offered to those in civil unions and domestic partnerships.

According to the National Conference for State Legislatures, five states now recognize civil unions: 

  • Colorado
  • Hawaii
  • Illinois
  • Vermont 
  • New Jersey

Another six states and the District of Columbia recognize domestic partnerships. The states on this list are: 

  • California
  • Maine
  • Nevada
  • Oregon
  • Washington 
  • Wisconsin 

Hawaii recognizes “reciprocal beneficiaries,” which are similar to domestic partnerships.

Are children of domestic partners covered under health plans?

Yes, children of domestic partners are typically covered under health insurance plans.

“Typically, if an employer’s health insurance provides coverage to domestic partners, then children of that partnership usually meet the definition of dependent and can obtain coverage,” Lee says. 

However, Lee adds that employees in domestic partnerships should review the health insurance benefit plan document and their company benefits administrator to make sure their children are covered.

How do you add a domestic partner to your health insurance?

Adding a domestic partner to your health insurance coverage follows a process akin to that of adding a spouse. You have the option to include partners during the initial enrollment, open enrollment period, or a special enrollment period triggered by a qualifying life event, such as the arrival of a new child.

Most states recognize domestic partnerships and allow them to enjoy the same health insurance benefits as married couples. Although the rules vary by state, you may need to check with your employer if they offer domestic partner health insurance coverage and what it covers if they do.

Do Medicare and Medicaid recognize domestic partnerships? 

No, Medicare and Medicaid don’t recognize domestic partnerships. 

Similar to the IRS, Medicare and Medicaid don’t offer health benefits to domestic partners. They’re governed by federal law, which doesn’t recognize or afford benefits to domestic partners.

What are the tax implications for domestic partner health insurance? 

The tax arena is one area with a clear difference between spousal insurance and domestic partner insurance.

Federal law dictates that spouses’ and dependents’ health insurance premiums can’t be taxed. However, domestic partnerships aren’t recognized by the federal government. So, the premiums paid for that partner and dependents are considered income for tax purposes.

That means the employee will have to pay income tax and Social Security taxes on that premium every paycheck.

What are the healthcare rights for people in domestic partnerships? 

Domestic partnerships aren’t federally recognized, so the rights and responsibilities surrounding them vary by state. Some states allow hospital visitation and medical decision-making benefits, while others don’t.

For example, Washington state offers domestic partnerships for those older than 62 and their partners as long as they are at least 18 years of age and cohabitate. The reason that Washington allows domestic partnerships based on age is that some seniors might lose pension benefits from a previous spouse if they remarry.

If the couple qualifies, domestic partners may have hospital visitation rights, make medical decisions for their partner, take paid medical leave to care for their ill partner, have bereavement leave, and can plan a funeral and burial.

Frequently Asked Questions

How do you become a domestic partner?

The rules for becoming a domestic partner vary by state. In most cases, you need to fill out and sign forms and pay a fee before the state recognizes your partnership. Check with your state to learn the rules you must follow. 

Can straight couples get domestic partnerships?

Straight couples may be allowed to register in domestic partnerships in some states. For example, California law recently changed to allow straight couples to pursue this option. 

Other states might allow the option, but only if one or both members of the couple are at least 62. That is because 62 is the age at which couples can file for Social Security benefits, and in some cases, couples can get higher Social Security benefits if they remain unmarried.

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Chris Kissell
Contributing Researcher


Chris Kissell is a Denver-based writer and editor with work featured on U.S. News & World Report, MSN Money, Fox Business, Forbes, Yahoo Finance, Money Talks News and more.