What Domestic Violence Survivors Need to Know About Affordable Health Care

Woman's face

Today’s guest blogger is Lena O’Rourke, Founder and Principal of O’Rourke Health Policy Strategies, which is committed to developing and implementing good public policy on health care issues, with an eye toward making our nation’s health care system work.

Over the last several months, over 12 million people successfully enrolled health insurance through the Insurance Marketplaces and through healthcare.gov. This is an incredible accomplishment, and I want to give a shout out to all of our partners in the field who worked so hard on outreach and enrollment!

Access to high-quality, affordable health coverage can make a critical difference in the lives of survivors of domestic violence and sexual abuse.

While Open Enrollment is now closed for coverage in 2016, survivors and can still qualify for special enrollment. Survivors of domestic violence may apply for health insurance through healthcare.gov at any time during the year.

This Special Enrollment Period is available to all survivors, regardless of gender, who live in states that use the federal Health Insurance Marketplace (also known as healthcare.gov), and some state-based Marketplaces. This also applies to members of federally-recognized Tribes.

What survivors need to do to be eligible for the Special Enrollment Period:

  • Call the healthcare.gov call center at 1-800-318-2596.
  • Explain the situation by stating “I am a survivor of domestic violence. I need health insurance. I want a Special Enrollment to apply for health care.”
  • The call center will grant the Special Enrollment Period and the survivor will have 60 days to pick and enroll in a plan for prospective coverage.

It’s very important to use the phrase “survivor of domestic violence” as it will help the call center initiate the appropriate process.

Some survivors of domestic violence may qualify for significant financial help for the purchase of health insurance. 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 towards their household income. This means that these individuals are able to qualify for financial help based on their own salary—making needed health insurance much more affordable.

In order to do this, survivors of domestic violence who meet the criteria must mark “not married” on their healthcare.gov application. This is the only way that the online application is able to process the applications. After they have completed the application, survivors will be able to see what financial help they are eligible for based only on their income.

How to apply for financial support WITHOUT including spouse’s income:

  • Mark “not married” on the healthcare.gov application. This will allow the appropriate eligibility determination for financial help.
  • Choose a plan that best meets the survivor’s needs and enroll in the plan.

It is important to note that this is official Internal Revenue Service and Health and Human Service guidance. This is how these federal agencies have formally recommended that victims of domestic violence apply. If they meet the criteria listed above, these individuals will not face a penalty for indicating that they are not married—when they actually are married.

No documentation is needed to prove domestic violence on the healthcare.gov application. But married survivors who get the special domestic violence 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 “domestic violence exception” will have to certify on their tax form that he or she fits the criteria—though no documentation is required.