Millions of people have enrolled in health insurance for 2018 through state insurance marketplaces and healthcare.gov. Connecting survivors to health insurance is critically important, and it means that people across the country are covered and will be able to access necessary health services.
It is no longer possible for most people to sign up for private health insurance; however, there are certain special circumstances—including experiencing domestic violence—that make it possible to get a special enrollment period (“SEP”) to sign up for health insurance outside of open enrollment.
Other SEPs include losing health insurance due to legal separation or divorce, moving to a new home in a new county, or losing health insurance in the last 60 days.
Thanks to the DV SEP, most survivors of domestic violence may apply for health insurance through healthcare.gov at any time during the year. This policy applies to survivors regardless of gender.
This SEP is available to all survivors who live in states that use the federal Health Insurance Marketplace (also known as healthcare.gov), as well as to members of federally recognized Tribes. Some state-based marketplaces have also adopted this rule.
How to Enroll
To enroll, survivors must call the Marketplace Call Center and say that they are/were a “survivor” or “victim” of domestic violence. It is important to use the phrases “survivor” or “victim” of DV, as it will help the Call Center initiate the appropriate process. The Call Center representative will be able to grant a SEP. It is not possible to start this process online.
Once a survivor is granted the SEP, they can complete the process—and they will have 60 days to pick a plan and get enrolled. (Note that this policy applies to the federal Marketplace/healthcare.gov; some state-based marketplaces also follow this policy, so check with your state).
To get a Special Enrollment Period, survivors should:
- Call the healthcare.gov Call Center at 1-800-318-2596.
- Explain the situation by stating, “I am a survivor of domestic violence. I want a Special Enrollment to apply for health care.”
- The Call Center will grant a SEP and then consumers will have 60 days to pick and enroll in a plan for prospective coverage.
No documentation or “proof” of domestic violence is required to apply for a SEP. But survivors must attest that they meet the criteria.
Significant financial help is available to all consumers who qualify. This is true both during open enrollment and during special enrollment periods. The application will ask for information about income in order to determine what type of financial help will be available.
The application requires all members of the family to report their income in order get a complete picture of the household’s income. When a couple is married, both people are required to report their income. Eligibility determinations for financial help will be based on the household income.
Survivors of domestic violence and abandoned spouses who are legally married but who do not live with their spouse and will file taxes separately are not required to count the spouse’s income toward their household income. This means that these consumers are able to qualify for financial help based on their own salary—making needed health insurance much more affordable to these victims.
In order to get access to financial support, survivors of domestic violence who meet the criteria must mark “not married” on their healthcare.gov application. This is the only way that online marketplaces are able to process the applications. After they have completed the application, consumers will be able to see what financial help they are eligible for based only on their income.
It is important to note that this is official IRS and HHS guidance. This is how these federal agencies have formally recommended that victims of domestic violence apply. If they meet the criteria listed above, these consumers will not face a penalty for indicating that they are not married—when they actually are married.
- Consumers must mark “not married” on the healthcare.gov application. This will allow the appropriate eligibility determination for financial help.
- Consumers can then choose a plan that best meets their needs and enroll in the plan.
While no documentation is needed to prove domestic violence on the healthcare.gov application, married survivors who get the special DV relief will need to “attest” on the next year’s tax return that the victim is unable to file taxes jointly due to domestic abuse. This means that anyone who receives financial help based on this “DV exception” will have to certify on their tax form that he or she fits the criteria—though no separate documentation is required.
For more information, visit the healthcare.gov webpage on SEP here.