CACs Eligibility and Enrollment Process 2 — Questions and Answers
Question 1: A consumer loses job-based health coverage on March 15. How many days does she have to enroll in a Marketplace plan through a Special Enrollment Period?
- 30 days from the loss of coverage
- 60 days from the loss of coverage (Correct answer)
- 90 days from the loss of coverage
- She must wait for Open Enrollment
Correct answer: 60 days from the loss of coverage
Consumers who lose qualifying health coverage have a 60-day Special Enrollment Period to enroll in a Marketplace plan.
Question 2: Which of the following is NOT a qualifying life event that triggers a Special Enrollment Period?
- Getting married
- Having a baby
- Voluntarily dropping existing coverage (Correct answer)
- Moving to a new coverage area
Correct answer: Voluntarily dropping existing coverage
Voluntarily dropping existing coverage is not a qualifying life event; SEPs are triggered by involuntary loss or specific life changes.
Question 3: A couple gets divorced on June 1. The spouse who was covered under the other's plan loses coverage. When does the SEP window close?
- June 15
- June 30
- July 31 (Correct answer)
- August 1
Correct answer: July 31
Loss of coverage due to divorce triggers a 60-day SEP, so coverage starting from June 1 gives until July 31 to enroll.
Question 4: Which Native American or Alaska Native enrollment rule differs from standard Marketplace rules?
- They cannot enroll in Marketplace plans
- They may enroll or change plans once per month outside of Open Enrollment (Correct answer)
- They are exempt from the individual mandate penalty
- They receive automatic Medicaid enrollment
Correct answer: They may enroll or change plans once per month outside of Open Enrollment
Members of federally recognized tribes and Alaska Natives can enroll in or change Marketplace plans once per month throughout the year.
Question 5: A consumer's Medicaid application is denied. How does this affect their Marketplace enrollment options?
- They lose the right to enroll for that plan year
- They receive a SEP to enroll in a Marketplace plan (Correct answer)
- They must reapply during Open Enrollment only
- They are automatically enrolled in a benchmark plan
Correct answer: They receive a SEP to enroll in a Marketplace plan
A denial of Medicaid or CHIP eligibility triggers a Special Enrollment Period for Marketplace coverage.
Question 6: What is the standard Open Enrollment Period for Marketplace health plans for the 2025 plan year?
- October 1 – December 15
- November 1 – December 15
- November 1 – January 15 (Correct answer)
- October 15 – January 31
Correct answer: November 1 – January 15
The federal Marketplace Open Enrollment Period for 2025 coverage runs from November 1 through January 15.
Question 7: A consumer moves from one state to another mid-year. Which statement best describes their enrollment options?
- They must wait until Open Enrollment to enroll in their new state
- They qualify for a SEP because moving to a new coverage area is a qualifying life event (Correct answer)
- They keep their old plan until the end of the plan year
- They must enroll in Medicaid before accessing the Marketplace
Correct answer: They qualify for a SEP because moving to a new coverage area is a qualifying life event
Moving to a new area where different Marketplace plans are available is a qualifying life event that triggers a Special Enrollment Period.
CACs Eligibility and Enrollment Process 2
A consumer loses job-based health coverage on March 15.
How many days does she have to enroll in a Marketplace plan through a Special Enrollment Period?