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When it comes to Qualifying Life Events for health insurance special enrollment, the qualifiers are often tough topics — from layoffs and deaths to divorce and heart-wrenching domestic violence. While we hope we will never have to face these scenarios in our lives, sometimes we find ourselves in situations we never asked for, wanted or deserved.
In this article, we hope to lay out everything you need to know about getting new health insurance by using a Special Enrollment Period after suffering domestic violence and spousal abandonment.
Domestic Abuse Creates a Special Enrollment Period (SEP)
The first thing you need to understand about Qualifying Life Events are the Special Enrollment Periods that come along with them. A SEP is a 60-day window which allows people to change or sign up for new health insurance coverage outside of the regular limited yearly Open Enrollment Period.
To begin one of these Special Enrollment Periods, you need have to have experienced a Qualifying Life Event — in this case, some form of domestic violence.
Those Who Have Suffered Domestic Abuse Have a Different SEP
There is a huge misconception that those who suffer from domestic violence or abuse have to adhere to regular Special Enrollment Periods. In fact, since 2015, victims of domestic violence and spousal abandonment are actually able to apply for health insurance at any point during the year and with far fewer restrictions.
Here’s how it works:
- The domestic violence SEP is available to both men and women
- No documentation is needed to prove domestic violence
- The victim may, at any point during the year, request to apply and enroll in coverage for themselves and dependents through the Federal Marketplace
- Once the request is made, at any point in the year, you then have 60 days to enroll in coverage
At any point after suffering from domestic violence you may request enrollment by calling the healthcare.gov call center hotline, (800) 318-2596. With domestic violence as a Qualifying Life Event, you can only call to request a SEP. This step cannot be done online.
Domestic Violence as a Qualifying Life Event
After suffering domestic violence or abuse, it’s hard to figure out what to do next. Getting your life in order can be tricky during this incredibly stressful time, but you have the power to move forward and take care of yourself. And part of that process might be withdrawing from your spouse, partner or household member’s health insurance, and getting on your own plan to gain further independence from them and the toxic situation.
But just because you have a flexible SEP due to domestic violence or spousal abandonment, it doesn’t mean you should wait too long to enroll. Taking care of your health is one of the most important things you can do for yourself going forward. So when you are ready to take that step, you should do so.
What Qualifies as Domestic Abuse for This QLE?
According to the Centers for Medicare and Medicaid Services, individuals who have experienced domestic violence are those who have encountered one of the following issues:
- Physical abuse
- Psychological abuse
- Sexual abuse
- Emotional abuse, including efforts by the perpetrator to control, isolate, humiliate, and intimidate, or to undermine the consumer’s ability to reason independently
- Spousal abandonment: which means the victim is unable to locate their spouse after doing reasonable diligence and “taking all facts and circumstances into account”.
Who Exactly Qualifies for the Domestic Violence QLE?
As of 2015, when the rules were expanded, “any member of the household who is a victim of domestic abuse including unmarried and dependent victims within the household, and including spousal abandonment and their dependents,” according to the Centers for Medicare and Medicaid Services. In most cases, the effects of abuse still qualify you for a health insurance Special Enrollment Period of your choosing.
Taking Control: a Health Insurance Checklist for Domestic Violence and Spousal Abandonment Victims
If you are the victim of domestic violence or spousal abandonment, you are probably working through a very dark time in your life. We wanted to create an easy checklist that can work as a flashlight during this time, helping you figure out what to do next in order to keep your health in check by enrolling in new health insurance.
1. Call the healthcare.gov call center hotline at (800) 318-2596
- Tell them about your domestic violence or spousal abandonment situation
- Request a Special Enrollment Period (SEP) based on your domestic violence QLE
- You may be directed to a local call center in some states
2. After you formally request a SEP, you have 60 days to enroll in a health insurance plan
- Take this time to shop the Marketplace for the best plan for you and any of your dependents.
- You may receive additional payment help based on your income, especially if you have dependents. If you don’t receive health insurance payment help, you can use your SEP to qualify for more affordable plans on HealthCare.com.
3. Look for additional resources
- This handout from the Centers for Medicare and Medicaid Services outlines healthcare scenarios and answers questions tax positioning, too.
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