Key Takeaway: As of April 29, 2015, an SEP is once again available to eligible consumers who are survivors or victims of domestic violence or spousal abandonment so that they may enroll in a QHP through the Marketplace with advanced payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs), if eligible. This SEP is now available through the Marketplace Call Center.
As an assister, you may be in a position to help a survivor of domestic violence or spousal abandonment qualify for a special enrollment period (SEP) and apply for coverage through the Marketplace separately from their spouse.
CMS had previously established a time limited SEP to enable consumers who are survivors of domestic violence to enroll in a qualified health plan (QHP) through the Marketplace. This SEP was previously available to consumers through June 1, 2014. NEW: As of April 29, 2015, this SEP is once again available to eligible consumers who are survivors of domestic violence/abuse or spousal abandonment so that they may enroll in a QHP through the Marketplace with advanced payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs), if eligible. This SEP is available to survivors of domestic violence, survivors of domestic abuse or spousal abandonment. Spousal abandonment, sometimes referred to as desertion, refers to when an individual cannot locate his or her spouse after making a reasonable attempt to find the spouse. To access this SEP, eligible consumers should call the Marketplace Call Center at 1-800-318-2596 to explain that they are a survivor of domestic violence, victim of domestic abuse, or survivor or victim of spousal abandonment.
When completing their Marketplace application, consumers should indicate that they are not married on the application. Upon qualifying for the SEP, consumers will have 60 days to select and enroll in a QHP. They will receive regular, prospective coverage effective date following the 15th of the month rule.
Eligible consumers may tell you that they assumed or were informed that they were ineligible for APTC because they are married and not filing a joint tax return with their spouse. While this is generally true, there is relief for consumers in specific situations, including for survivors of domestic violence and spousal abandonment, as specified in IRS Publication 971: Innocent Spouse Relief. More details about filing taxes separately for individuals who meet these criteria are available on page three of the 2014 Instructions for Form 8962 Premium Tax Credit (PTC). In addition, consumers who were not able to get coverage earlier in the year due to their domestic situation may be eligible for an exemption from the individual shared responsibility requirement or “fee” for not having coverage. More information about exemptions is here.