CEC Eligibility Determination Process 2 — Questions and Answers
Question 1: A consumer reports income that fluctuates month to month. How should an enrollment counselor best project annual income for APTC eligibility?
- Use only the most recent month's income multiplied by 12
- Average the last 3 months and annualize that figure
- Use the consumer's best estimate of expected annual income (Correct answer)
- Require the consumer to submit 12 months of pay stubs
Correct answer: Use the consumer's best estimate of expected annual income
Marketplaces use the applicant's reasonable estimate of expected annual income, not a mechanical formula based on past pay periods.
Question 2: Which document is generally NOT acceptable as proof of U.S. citizenship for Marketplace enrollment purposes?
- U.S. passport
- Birth certificate issued by a U.S. state
- Voter registration card alone (Correct answer)
- Certificate of Naturalization (N-550)
Correct answer: Voter registration card alone
A voter registration card alone is not an accepted citizenship document; it must be accompanied by another primary document.
Question 3: A 28-year-old applicant is offered employer-sponsored insurance that covers only the employee, not dependents. The spouse applies separately through the Marketplace. Which standard applies to the spouse's APTC eligibility?
- The spouse is ineligible because the employee has an offer of employer coverage
- The spouse's APTC eligibility is based on whether the employee-only premium exceeds the affordability threshold
- The spouse is automatically eligible because dependent coverage was not offered
- The family glitch rule makes the spouse eligible based on the family premium cost (Correct answer)
Correct answer: The family glitch rule makes the spouse eligible based on the family premium cost
Under the 2023 'family glitch' fix, dependents' APTC eligibility is evaluated against the cost of family coverage, not the employee-only premium.
Question 4: During a Special Enrollment Period triggered by loss of MEC, how many days does a consumer generally have to enroll in a Marketplace plan?
- 30 days from the loss event
- 60 days from the loss event (Correct answer)
- 90 days from the loss event
- Until the end of the current calendar year
Correct answer: 60 days from the loss event
Loss of minimum essential coverage triggers a 60-day Special Enrollment Period.
Question 5: An applicant's household includes a non-citizen spouse who is ineligible for Marketplace coverage. How is household income calculated for APTC purposes?
- The non-citizen spouse's income is excluded entirely
- All household members' income is counted regardless of immigration status
- Only the income of citizens in the household is counted
- The non-citizen spouse's income is counted but their coverage need is excluded (Correct answer)
Correct answer: The non-citizen spouse's income is counted but their coverage need is excluded
The non-citizen spouse's income is included in MAGI household income but they are not counted in the tax family size for benchmark plan calculation.
Question 6: A consumer loses their job on March 15 and their employer coverage ends April 30. When does their 60-day SEP window begin?
- March 15 (date of job loss)
- April 1 (first of the following month)
- April 30 (date coverage actually ends) (Correct answer)
- May 1 (day after coverage ends)
Correct answer: April 30 (date coverage actually ends)
The SEP window is triggered by the date coverage actually ends, not the date of the qualifying event that caused the loss.
Question 7: Which income is excluded from MAGI-based household income for Marketplace eligibility?
- Self-employment net profit
- Social Security retirement benefits that are taxable
- Child support received (Correct answer)
- Alimony received under pre-2019 divorce decrees
Correct answer: Child support received
Child support received is not included in MAGI and therefore is excluded from household income calculations for Marketplace eligibility.
CEC Eligibility Determination Process 2
A consumer reports income that fluctuates month to month.
How should an enrollment counselor best project annual income for APTC eligibility?