CACs Ethics and Impartiality 2 — Questions and Answers
Question 1: A CAC is helping a client who qualifies for both Medicaid and a Marketplace plan with subsidies. The client asks which is better. What is the ethical approach?
- Recommend Medicaid because it has no premiums
- Recommend the Marketplace plan because it has more providers
- Explain both options objectively and let the client decide based on their needs (Correct answer)
- Decline to discuss Medicaid since CACs only assist with Marketplace enrollment
Correct answer: Explain both options objectively and let the client decide based on their needs
CACs must present all eligible coverage options impartially so clients can make informed decisions that suit their individual circumstances.
Question 2: A CAC discovers during an enrollment session that a client's employer offers coverage that may be considered affordable under ACA rules. What should the CAC do?
- Ignore employer coverage and proceed with Marketplace enrollment
- Inform the client about the employer offer and explain how it may affect subsidy eligibility (Correct answer)
- Enroll the client in Marketplace and let the IRS sort it out later
- Advise the client to decline employer coverage without explaining the consequences
Correct answer: Inform the client about the employer offer and explain how it may affect subsidy eligibility
CACs must inform clients of facts that affect their eligibility, including the impact of affordable employer coverage on Marketplace subsidies.
Question 3: Which of the following actions would constitute a conflict of interest for a CAC?
- Helping a client compare two different insurance carriers
- Receiving a commission from an insurer for enrolling clients in their plans (Correct answer)
- Explaining premium tax credit calculations to a client
- Assisting a client who is a family member
Correct answer: Receiving a commission from an insurer for enrolling clients in their plans
Receiving financial compensation from insurers for enrollments creates a conflict of interest that compromises the CAC's required impartiality.
Question 4: A client asks a CAC to recommend the plan with the lowest monthly premium without considering other cost-sharing factors. What is the most ethical response?
- Select the lowest-premium plan as the client requested
- Explain that total costs include deductibles and copays, then help the client compare all cost factors (Correct answer)
- Refuse to assist because the client's approach is unwise
- Select a moderate plan and tell the client it has the lowest premium
Correct answer: Explain that total costs include deductibles and copays, then help the client compare all cost factors
Ethical CAC practice requires ensuring clients have complete cost information, including deductibles and out-of-pocket maximums, not just premiums.
Question 5: Under CAC ethical standards, how should a CAC handle a situation where they are not able to answer a client's complex tax question related to the premium tax credit?
- Provide a best guess to avoid seeming unknowledgeable
- Tell the client the question is irrelevant to enrollment
- Acknowledge the limitation and refer the client to a tax professional or IRS resources (Correct answer)
- Proceed with enrollment without addressing the question
Correct answer: Acknowledge the limitation and refer the client to a tax professional or IRS resources
CACs must operate within their scope of expertise and refer clients to appropriate professionals when questions exceed that scope.
Question 6: A CAC's employer instructs them to prioritize enrolling clients in a specific health plan. How should the CAC respond?
- Follow the employer's instructions since the employer sets the policies
- Enroll clients in that plan only if it genuinely fits their needs after an impartial review
- Report the instruction to CMS as a potential compliance violation (Correct answer)
- Resign immediately to avoid the conflict
Correct answer: Report the instruction to CMS as a potential compliance violation
Instructions to steer clients to specific plans violate CAC impartiality requirements and should be reported to CMS as a compliance concern.
Question 7: A client shares information during enrollment that suggests potential eligibility fraud. What is the CAC's ethical obligation?
- Complete the enrollment and stay silent to protect client privacy
- Assist the client in accurately reporting their information and advise against false statements (Correct answer)
- Refuse to assist the client and ask them to leave
- Report the client to law enforcement immediately
Correct answer: Assist the client in accurately reporting their information and advise against false statements
CACs must assist clients in providing accurate information and must not facilitate or ignore potential fraud during the enrollment process.
CACs Ethics and Impartiality 2
A CAC is helping a client who qualifies for both Medicaid and a Marketplace plan with subsidies.
The client asks which is better.
What is the ethical approach?