CACs Special Enrollment Periods and Life Events 2 — Questions and Answers
Question 1: Which qualifying life event allows a consumer to enroll in a Marketplace plan even if they previously had coverage?
- Voluntary disenrollment from a prior plan
- Loss of minimum essential coverage (Correct answer)
- Starting a new job without benefits
- Enrolling in a gym membership
Correct answer: Loss of minimum essential coverage
Losing minimum essential coverage involuntarily — such as a job loss — qualifies a consumer for a Special Enrollment Period.
Question 2: A couple gets divorced and one spouse loses coverage. When does their SEP begin?
- On the date the divorce is filed
- On the date the divorce is finalized and coverage is lost (Correct answer)
- 60 days before the divorce
- There is no SEP for divorce
Correct answer: On the date the divorce is finalized and coverage is lost
The SEP begins on the date coverage is lost due to divorce, not when the divorce is merely filed.
Question 3: Which government program losing eligibility can trigger a SEP for Marketplace coverage?
- Medicare Part A
- SNAP food assistance
- Medicaid or CHIP (Correct answer)
- Social Security Disability Insurance
Correct answer: Medicaid or CHIP
Losing eligibility for Medicaid or CHIP is a qualifying life event that opens a Special Enrollment Period for Marketplace plans.
Question 4: What documentation might a CAC help a consumer gather to verify a qualifying life event for a SEP?
- A signed affidavit from a neighbor
- A letter showing loss of prior coverage or a birth certificate (Correct answer)
- A social media post confirming the event
- No documentation is ever required
Correct answer: A letter showing loss of prior coverage or a birth certificate
Consumers may be asked to provide documents like a coverage termination letter or birth certificate to verify their qualifying life event.
Question 5: A consumer's employer stops offering health insurance. How soon should the consumer contact a CAC to use their SEP?
- Within the first week only
- As soon as possible within the 60-day window (Correct answer)
- After the 60-day window closes
- Only during Open Enrollment
Correct answer: As soon as possible within the 60-day window
Consumers should act as soon as possible within their 60-day window to ensure they have enough time to select and enroll in a plan.
Question 6: Which of the following best describes the role of a CAC when a consumer experiences a qualifying life event?
- File a complaint with CMS on the consumer's behalf
- Help the consumer understand their SEP eligibility and assist with enrollment (Correct answer)
- Automatically enroll the consumer in the lowest-cost plan
- Notify the IRS of the consumer's change in status
Correct answer: Help the consumer understand their SEP eligibility and assist with enrollment
A CAC's role is to help consumers understand their SEP options and assist them in navigating the enrollment process.
CACs Special Enrollment Periods and Life Events 2
Which qualifying life event allows a consumer to enroll in a Marketplace plan even if they previously had coverage?