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What Are Domestic Violence and Health Insurance Protections?

By Cate Misczuk

Cate Misczuk

Cate Misczuk is a freelance lifestyle writer who covers health, wellness and insurance topics that directly affect consumers.

Updated on March 8th, 2021

Reviewed by Frank Lalli

Frank Lalli

After Frank Lalli, the former editor of Money and George magazines, was diagnosed with Multiple Myeloma, a potentially deadly blood cancer, he turned his experiences with our health care system into becoming The Health Care Detective™ and the author of Simon & Schuster’s Your Best Health Care – Now. He also reports regularly for National Public Radio’s Robin Hood Radio and Parade magazine to help people make better health care decisions and save money, too. In addition, he has testified twice before the U.S. Congress as an expert witness.

In this Article

Domestic Abuse Creates a Special Enrollment Period (SEP) The Many Forms of Domestic Violence Are Qualifying Life Events

We want to help you make educated healthcare decisions. While this post may have links to lead generation forms, this won’t influence our writing. We adhere to strict editorial standards to provide the most accurate and unbiased information.

Despite the incredible stress of enduring domestic violence or abuse, understand that you have the power to move forward and take care of yourself. Part of that process might be getting your own health insurance and withdrawing from your spouse, partner or household member’s insurance plan to gain further independence from a toxic situation.

As you may know, most people can only enroll in a health insurance plan during open enrollment — a set time period at the end of the year, usually lasting a little longer than a month. However, there are exceptions when people experience Qualifying Life Events (QLE). Unfortunately, these events are often bad experiences, such as layoffs, death of a loved one, and domestic violence. But if you do experience one of these events, you don’t have to wait for the open enrollment period. 

This article spells out everything you need to know about getting new health insurance by using a Special Enrollment Period (SEP), specifically after suffering domestic violence and spousal abandonment.

Domestic Abuse Creates a Special Enrollment Period (SEP)

The first thing you need to understand about QLE is that they trigger a SEP – a 60-day window where people can change their health plan or sign up for new insurance coverage during any time of the year. That means you don’t need to wait for the late-year Open Enrollment Period to make insurance moves. Domestic violence and abuse are recognized as QLE. 

Those Who Have Suffered Domestic Abuse Have a Different SEP

Those who suffer domestic violence or abuse qualify for a generous SEP. Since 2015, victims of domestic violence and spousal abandonment can apply for health insurance at any point during the year and with far fewer restrictions than a regular SEP. The domestic violence SEP is available to both men and women.

 Here’s how it works: No documentation is needed to prove domestic violence.

  • The victim may, at any point during the year, request to apply and enroll in Affordable Care Act (Obamacare) coverage for themselves and dependents through the Federal Marketplace and in some state marketplaces.
  • Once the request is made, you then have 60 days to enroll in coverage.

After suffering domestic violence, you may request a SEP to get health insurance immediately by calling the healthcare.gov call center hotline: (800) 318-2596. You must call, you can’t complete this step online. 

The Many Forms of Domestic Violence Are Qualifying Life Events

Once you are granted a SEP do not wait too long to enroll in a health insurance plan. Remember, you only have 60 days to enroll. More importantly, taking care of your health is one of the most important things you can do as you go forward. 

What Qualifies as Domestic Abuse?

According to the Centers for Medicare and Medicaid Services, individuals have experienced domestic violence if they have endured any of the following:

  • Physical abuse;
  • Psychological abuse;
  • Sexual abuse;
  • Emotional abuse, including efforts by the perpetrator to control, isolate, humiliate, and intimidate, or to undermine the victim’s ability to reason independently
  • Spousal abandonment, which means the victim is unable to locate his or her spouse after trying diligently and “taking all facts and circumstances into account”.

Who Exactly Qualifies for 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” is considered a survivor of domestic abuse and qualifies. Survivors and their dependents of spousal abandonment also qualify, according to the Centers for Medicare and Medicaid Services. 

Taking Control: A Health Insurance Checklist for Domestic Violence and Spousal Abandonment Survivors 

If you are a survivor of domestic violence or spousal abandonment, you are probably working through a very dark time in your life. Here is an easy checklist that can serve as a flashlight during this time, helping you figure out what to do next 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 the representative about your domestic violence or spousal abandonment situation.
  • Request a Special Enrollment Period (SEP) based on your domestic violence QLE.
  • Be aware that you may be directed to a local call center in some states.

2. After you are granted 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 your dependents.
  • You may be eligible for additional payment assistance based on your income, especially if you have dependents. If you don’t qualify for that financial help, you may still qualify for affordable ACA insurance plans with subsidies on HealthCare.com.

3. Look for additional resources

This handout from the Centers for Medicare and Medicaid Services outlines healthcare scenarios and answers a general question about how survivors can file tax returns.

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