CACs - Certified Application Counselor Health Coverage Programs Questions and Answers 1 — Questions and Answers
Question 1: A 45-year-old single adult with no disabilities has an annual income that is 120% of the Federal Poverty Level (FPL). They live in a state that has expanded its Medicaid program. Which health coverage program are they most likely eligible for?
- A subsidized Marketplace plan
- Medicare
- Medicaid (Correct answer)
- Children's Health Insurance Program (CHIP)
Correct answer: Medicaid
In states that have expanded Medicaid under the Affordable Care Act (ACA), non-disabled adults under age 65 with household incomes up to 138% of the FPL are generally eligible for Medicaid. Since this individual's income is at 120% FPL, they would qualify for Medicaid.
Question 2: What is the primary purpose of the Children's Health Insurance Program (CHIP)?
- To provide health coverage to adults over the age of 65.
- To offer private health insurance options to small business owners.
- To provide low-cost or free health coverage for children in families who earn too much to qualify for Medicaid but cannot afford private insurance. (Correct answer)
- To supplement Medicare coverage for individuals with disabilities.
Correct answer: To provide low-cost or free health coverage for children in families who earn too much to qualify for Medicaid but cannot afford private insurance.
CHIP provides health coverage to uninsured children in families with incomes that are too high to qualify for Medicaid but too low to afford private coverage. It is specifically designed to cover this gap population of children.
Question 3: An individual is generally eligible for Medicare before the age of 65 under which of the following circumstances?
- They have a household income below 100% of the Federal Poverty Level.
- They have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months. (Correct answer)
- They are a veteran of the armed forces.
- They have been unemployed for more than 12 consecutive months.
Correct answer: They have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months.
Individuals under 65 can qualify for Medicare if they have a qualifying disability. Typically, this eligibility begins after they have received Social Security Disability Insurance (SSDI) benefits for 24 months. Other qualifying conditions include End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS).
Question 4: Which of the following is a key requirement for an individual to be eligible for Advance Premium Tax Credits (APTCs) to lower the cost of a Health Insurance Marketplace plan?
- The individual must be eligible for affordable employer-sponsored coverage.
- The individual's household income must be below 100% of the Federal Poverty Level.
- The individual must not be eligible for other minimum essential coverage, like Medicaid or Medicare. (Correct answer)
- The individual must be over the age of 65.
Correct answer: The individual must not be eligible for other minimum essential coverage, like Medicaid or Medicare.
To qualify for APTCs, an individual must not be eligible for other forms of minimum essential coverage, such as Medicaid, Medicare, or affordable employer-sponsored insurance. They must also have a household income between 100% and 400% of the FPL (with exceptions extending this range due to recent legislation).
Question 5: Maria is a single mother with one child, age 10. Their household income is 150% of the FPL. Her state has expanded Medicaid to 138% FPL for adults, and its CHIP program covers children in families with incomes up to 200% FPL. What are the likely eligibility determinations for Maria and her child?
- Both Maria and her child are eligible for Medicaid.
- Maria is eligible for a subsidized Marketplace plan, and her child is eligible for CHIP. (Correct answer)
- Both Maria and her child are eligible for a subsidized Marketplace plan.
- Maria is not eligible for any assistance, but her child is eligible for Medicaid.
Correct answer: Maria is eligible for a subsidized Marketplace plan, and her child is eligible for CHIP.
Maria's income at 150% FPL is above the 138% FPL threshold for adult Medicaid in her state, making her ineligible for that program. However, her income is within the range for Marketplace subsidies. Her child's eligibility is determined separately; since the household income of 150% FPL is below the state's 200% FPL limit for CHIP, the child will likely qualify for CHIP.
Question 6: If an applicant is found eligible for Medicaid during the Marketplace application process, what is the immediate next step?
- The applicant must select a private insurance plan before Medicaid can begin.
- The Marketplace will deny the application and the applicant must start over with the state Medicaid agency.
- The Marketplace application is suspended for 90 days to allow for an income review.
- The Marketplace transfers the individual's account information to the state Medicaid agency for enrollment. (Correct answer)
Correct answer: The Marketplace transfers the individual's account information to the state Medicaid agency for enrollment.
The Health Insurance Marketplace application serves as a single point of entry for multiple health coverage programs. If the system determines that an applicant is likely eligible for Medicaid or CHIP, their information is securely transferred to the relevant state agency to complete the enrollment process.
CACs - Certified Application Counselor Health Coverage Programs Questions and Answers 1
A 45-year-old single adult with no disabilities has an annual income that is 120% of the Federal Poverty Level (FPL).
They live in a state that has expanded its Medicaid program.
Which health coverage program are they most likely eligible for?