CEC Application and Enrollment Procedures 4 — Questions and Answers
Question 1: What is the maximum length of a COBRA continuation coverage period for a qualifying event of termination of employment?
- 12 months
- 18 months (Correct answer)
- 24 months
- 36 months
Correct answer: 18 months
COBRA provides up to 18 months of continuation coverage for qualifying events such as voluntary or involuntary job loss.
Question 2: An applicant is unsure whether their household qualifies for Medicaid or a Marketplace plan. What should the enrollment counselor do?
- Enroll them in both programs simultaneously
- Screen the applicant's income against FPL guidelines to determine the appropriate program (Correct answer)
- Refer them only to their employer
- Tell them to call 911
Correct answer: Screen the applicant's income against FPL guidelines to determine the appropriate program
Counselors should compare the household's modified adjusted gross income to the Federal Poverty Level thresholds to determine Medicaid versus Marketplace eligibility.
Question 3: Under the ACA, what is the maximum out-of-pocket limit for an individual in a plan year for in-network services?
- $5,000
- $7,000
- $9,450 (2024 figure; indexed annually) (Correct answer)
- $12,000
Correct answer: $9,450 (2024 figure; indexed annually)
The ACA sets an annual out-of-pocket maximum that is indexed each year; for 2024 it is $9,450 for individual coverage.
Question 4: Which metal tier plan has the highest actuarial value under ACA Marketplace rules?
- Bronze
- Silver
- Gold
- Platinum (Correct answer)
Correct answer: Platinum
Platinum plans have the highest actuarial value of approximately 90%, meaning the plan pays about 90% of covered costs on average.
Question 5: A consumer wants to enroll in a Marketplace plan after losing Medicaid eligibility. Which SEP applies?
- Birth/adoption SEP
- Loss-of-minimum-essential-coverage SEP (Correct answer)
- Marriage SEP
- Move SEP
Correct answer: Loss-of-minimum-essential-coverage SEP
Loss of Medicaid qualifies as a loss of minimum essential coverage, triggering a Special Enrollment Period for Marketplace plans.
Question 6: What information is typically NOT required on a Marketplace health insurance application?
- Social Security number (or explanation of why unavailable)
- Household income estimate
- Current employer's stock price (Correct answer)
- Immigration status for non-citizen applicants
Correct answer: Current employer's stock price
Stock prices are irrelevant to health insurance eligibility; the Marketplace requires income, identity, citizenship/immigration status, and household composition information.
Question 7: If a consumer does not reconcile their advance premium tax credit on their federal tax return, what consequence may occur?
- They lose their plan retroactively
- They may be required to repay excess APTC and could lose eligibility for future credits (Correct answer)
- The IRS automatically adjusts their subsidy with no penalty
- They receive a larger refund
Correct answer: They may be required to repay excess APTC and could lose eligibility for future credits
Failure to file Form 8962 to reconcile APTC can result in repayment of excess credits and disqualification from future advance payments.
CEC Application and Enrollment Procedures 4
What is the maximum length of a COBRA continuation coverage period for a qualifying event of termination of employment?