Guide to domestic partner health insurance

Many people now prefer living together over getting married, which raises an important question for millions about health insurance coverage—are domestic partners included?

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

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

In 2021, the U.S. marriage rate was 14.9% per 1,000 women, a decrease from 16.3% per 1,000 women a decade earlier, according to the United States Census Bureau report. This is the most recent data available.

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 the Pew Research Center.

Thankfully, the health insurance marketplace also offers domestic partnership benefits.

What is a domestic partnership? 

Tracy Burns, CEO of Northeast HR Association (NEHRA), explains that 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. 

“A domestic partnership is very similar to marriage. It can apply to couples who are not married but live together and provides some legal benefits that married couples enjoy,” Burns says. 

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? 

The primary difference between a domestic partnership and marriage is that marriage is a legally recognized union with rights and responsibilities at the federal and state levels, while a domestic partnership offers some legal benefits similar to marriage but is typically recognized only at the state or local level, often with fewer rights.

However, 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.”

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.

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.”

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. Washington allows domestic partnerships based on age because 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 plan a funeral and burial.

What’s the difference between domestic partner and spousal health insurance?

Spousal health insurance is coverage extended to a husband or wife through their partner’s health insurance plan. It’s commonly available through employer-sponsored plans or government programs like Medicaid and Medicare.

To be eligible, the person must be legally married to the policyholder. Usually, spouses are entitled to the same health insurance benefits and coverage as the primary policyholder.

On the other hand, domestic partner health insurance covers a person who lives with the policyholder in a long-term, committed relationship but is not legally married. 

Eligibility varies depending on the insurance company and employer, as some insurance plans allow domestic partners to be added if they meet certain criteria.

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

Adding a domestic partner to your health insurance is similar to adding a spouse. You can usually do it when you first enroll, during open enrollment, or after a major life event like the birth of a child.

To get domestic partner health insurance, both partners must meet specific criteria, which can vary by state and employer. Generally, the following requirements apply:

• Both individuals must be at least 18 and legally competent to consent to a contract.
• Neither partner should be married to someone else or in another domestic partnership.
• Many insurers require that you and your partner live together. Some may specify a minimum period, such as living together for six months or more.
• Not all employers offer domestic partner benefits, even if the insurance company allows it. Check with your human resources department to see if this option is available.
• You and your partner must not be related by blood in a manner that would prohibit marriage under state law.

What are the tax implications for domestic partner health insurance? 

Covering a domestic partner under your employer-sponsored health insurance can lead to extra taxation. Unlike with a legal spouse, the portion of the premium your employer pays for your partner is considered taxable income, which increases your W-2 earnings through something called imputed income. 

In most cases, you also can’t use pre-tax dollars to pay your partner’s share of the premium unless they qualify as your tax dependent under IRS rules. Since domestic partners aren’t recognized at the federal level, you won’t get the same tax breaks married couples do, and the rules can vary by state, so it’s important to understand both federal and state tax treatment before enrolling a partner in your plan.

Do Medicare and Medicaid recognize domestic partnerships? 

No, Medicare and Medicaid don’t recognize domestic partnerships. For Medicare, this means domestic partners can’t access spousal benefits and they aren’t eligible for certain enrollment exceptions available to spouses. Conversely, Medicaid treats domestic partners as separate individuals when determining eligibility, which can sometimes be beneficial for income-based qualifications. 

A few states offer limited protections for domestic partners — such as allowing them to stay in a shared home if one partner enters long-term care  — but these policies vary and are not guaranteed.

Can you get domestic partner health insurance through your employer?

You can get domestic partner health insurance through your employer, but it depends on your employer’s policies and the insurance plans they offer.

Employers that offer domestic partner benefits have specific criteria for defining a domestic partnership. This may include living together for a certain period, sharing financial responsibilities, not being married to someone else, and providing proof of the relationship through documentation, such as a joint lease or shared utility bills.

If your employer does not offer domestic partner benefits, your partner might consider:

• Enrolling in a health insurance plan through their own employer.
• Purchasing an individual health insurance plan through the health insurance marketplace.
• Exploring government programs like Medicaid if eligible.

What states recognize domestic partnerships?

An increasing number of states now extend legal rights to same-sex couples in civil unions or domestic partnerships, even if they’re not married.

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

• Colorado
• Hawaii
• Illinois
• New Jersey
• Vermont

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

• California
• Hawaii (via reciprocal beneficiary relationships)
• Maine
• Nevada
• New Jersey
• Oregon
• Washington
• Wisconsin

Depending on the state, domestic partners may qualify for benefits such as health insurance coverage, the ability to visit a partner in the hospital, and inheritance rights.

Domestic partnership laws by state

While domestic partnership laws vary across the U.S., some states offer formal recognition and legal protections for couples who aren’t married. From city-level registries to statewide rights equivalent to marriage, the rules and benefits differ widely. Below are examples of how domestic partnerships are handled in states like Colorado, Washington, California, and New Jersey.

How domestic partnerships work  in Colorado

The City of Boulder offers a Domestic Partnership Registry for couples who wish to have their relationship formally recognized without getting married. This registry is open to both same-sex and opposite-sex couples who meet specific criteria.

You can download the Domestic Partnership Registration form from the City of Boulder’s official website or pick it up at the City Clerk’s office. Both partners must fill out and sign the application in the presence of a notary public or a city official.

How domestic partnerships work  in Washington

In Washington state, domestic partners registered with the state have the same legal rights as married couples. The law ensures equal treatment for domestic partners as long as it doesn’t conflict with federal law.

The rights and benefits conferred upon domestic partners in Washington include the ability to make medical decisions on behalf of an incapacitated partner, hospital visitation rights, inheritance rights similar to those of spouses, parental rights concerning child custody and support, certain state tax benefits and access to family health insurance plans and family leave policies. 

How domestic partnerships work  in California

If both you and your partner are over 18, or if one or both of you are under 18 and have a court order permitting the formation of a domestic partnership, you can register your domestic partnership with the California Secretary of State, provided you meet the requirements outlined in the California Family Code.

You need to fill out a Declaration of Domestic Partnership Form DP-1, have both of your signatures notarized, and send the form along with the required fee to the California Secretary of State.

Under the law, registered domestic partners have the same rights, protections, and benefits as married couples. They are also responsible for the same duties and obligations as spouses.

How domestic partnerships work  in New Jersey

In New Jersey, same-sex couples aged 18 or older and opposite-sex couples aged 62 or older can register their domestic partnership under the Original Domestic Partnership Act.

To register, both applicants must complete and sign an Affidavit of Domestic Partnership in front of a notary. Then, submit the signed Affidavit to a Local Registrar of Vital Statistics with a $28 fee.

To register, both partners must be of same-sex or opposite sex who are both 62 years of age or older and meet these conditions:

• Live together in New Jersey or another location, as long as at least one partner is a New Jersey State retirement system member.
• Share financial responsibilities and living expenses.
• Not be married, in a civil union, or have another domestic partner.
• Must not be related by blood.
• Be committed to each other’s well-being.
• Not have ended another domestic partnership in the last 180 days (unless the other partner passed away).

Domestic partner health insurance offers a valuable alternative for couples who choose not to marry but still want access to shared benefits and financial protection. Since domestic partnership benefits and requirements vary by state, it’s important to contact your state’s health department, insurance commissioner, or local registrar to get accurate, up-to-date information for your situation.

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