CEC Application Assistance & Enrollment Procedures 2 — Questions and Answers
Question 1: A consumer submits an application on the last day of open enrollment but makes a payment error. What is the enrollment counselor's best course of action?
- Ignore the payment error and submit the application anyway
- Assist the consumer in correcting the payment error before the deadline passes (Correct answer)
- Tell the consumer they must wait until the next open enrollment period
- Cancel the application and start fresh next year
Correct answer: Assist the consumer in correcting the payment error before the deadline passes
Enrollment counselors should assist consumers in resolving payment errors before the enrollment deadline to ensure coverage is secured.
Question 2: Which document is typically required when a consumer claims a Special Enrollment Period (SEP) due to loss of employer-sponsored coverage?
- Tax return from the previous year
- Letter from the employer confirming loss of coverage and the date it ended (Correct answer)
- Social Security card
- Proof of citizenship only
Correct answer: Letter from the employer confirming loss of coverage and the date it ended
A letter or notice from the employer documenting coverage termination and the date serves as required proof for an SEP triggered by loss of job-based coverage.
Question 3: When assisting a consumer with a Marketplace application, what must an enrollment counselor do if the consumer is potentially eligible for Medicaid?
- Complete the Marketplace enrollment and ignore Medicaid eligibility
- Inform the consumer they are ineligible for any federal assistance
- Screen the consumer for Medicaid eligibility and facilitate a referral to the state Medicaid agency if appropriate (Correct answer)
- Enroll the consumer in the highest-premium plan to avoid Medicaid
Correct answer: Screen the consumer for Medicaid eligibility and facilitate a referral to the state Medicaid agency if appropriate
Enrollment counselors must screen for Medicaid/CHIP eligibility and refer consumers to the appropriate state agency when they may qualify.
Question 4: A family of four applying through the Marketplace includes a non-citizen spouse with a green card. How should the application handle this situation?
- Exclude the non-citizen spouse from the application entirely
- Include the spouse and enter their immigration status; lawfully present immigrants may qualify for coverage (Correct answer)
- Only include U.S. citizens on the application
- File a separate application for each family member
Correct answer: Include the spouse and enter their immigration status; lawfully present immigrants may qualify for coverage
Lawfully present immigrants, including green card holders, are generally eligible for Marketplace coverage and should be included on the household application.
Question 5: What is the purpose of the 'advance premium tax credit' (APTC) reconciliation process on Form 8962?
- To enroll in a new health plan for the upcoming year
- To compare the APTC received during the year with the actual credit amount owed based on final income (Correct answer)
- To request a Special Enrollment Period
- To verify Medicaid eligibility
Correct answer: To compare the APTC received during the year with the actual credit amount owed based on final income
Form 8962 reconciles the advance premium tax credits paid on a consumer's behalf with the actual credit they are entitled to based on their final annual income.
Question 6: During an enrollment session, a consumer asks whether their undocumented family members can be enrolled in a Marketplace plan. What is the correct response?
- Undocumented immigrants are eligible for the same Marketplace subsidies as citizens
- Undocumented immigrants are not eligible for Marketplace coverage but should not be included in the household's income calculation for other members' eligibility (Correct answer)
- Undocumented immigrants can enroll using a borrowed Social Security number
- All family members regardless of status can be enrolled without verification
Correct answer: Undocumented immigrants are not eligible for Marketplace coverage but should not be included in the household's income calculation for other members' eligibility
Undocumented immigrants are not eligible for Marketplace coverage or subsidies but their income is not counted when determining other household members' eligibility.
Question 7: A consumer enrolled in a Marketplace plan experiences a qualifying life event mid-year. Within how many days must they generally report the change and enroll in a new plan?
- 15 days
- 30 days
- 60 days (Correct answer)
- 90 days
Correct answer: 60 days
Most qualifying life events trigger a 60-day Special Enrollment Period during which consumers can change or enroll in a new Marketplace plan.
CEC Application Assistance & Enrollment Procedures 2
A consumer submits an application on the last day of open enrollment but makes a payment error.
What is the enrollment counselor's best course of action?