CES Marketplace and Exchange Navigation 1 — Questions and Answers
Question 1: What is the primary role of the Health Insurance Marketplace created by the ACA?
- To provide free health insurance to all Americans
- To offer a platform where individuals can compare and purchase qualified health plans (Correct answer)
- To replace Medicaid and Medicare with private coverage
- To regulate insurance premiums directly
Correct answer: To offer a platform where individuals can compare and purchase qualified health plans
The Health Insurance Marketplace is a structured platform where consumers can shop, compare, and enroll in ACA-compliant qualified health plans and apply for financial assistance.
Question 2: States that choose to run their own ACA exchange are called:
- Federally Facilitated Marketplaces (FFMs)
- State-Based Marketplaces (SBMs) (Correct answer)
- Partnership Exchanges
- Independent Insurance Pools
Correct answer: State-Based Marketplaces (SBMs)
States that build and operate their own ACA-compliant exchanges are called State-Based Marketplaces (SBMs), while other states use HealthCare.gov.
Question 3: A Navigator is a federally funded, certified professional who may:
- Sell health insurance plans for a commission
- Provide unbiased enrollment assistance at no cost to consumers (Correct answer)
- Deny applications on behalf of the Marketplace
- Only assist with Medicare enrollment
Correct answer: Provide unbiased enrollment assistance at no cost to consumers
Navigators are federally funded, trained, and certified to provide free, unbiased help with Marketplace applications, enrollment, and plan comparison without selling plans.
Question 4: Which of the following must an applicant provide to apply for Marketplace coverage?
- Medical history and pre-existing conditions
- Household size and estimated annual income (Correct answer)
- Employer permission to enroll in a Marketplace plan
- Credit score and financial assets
Correct answer: Household size and estimated annual income
Marketplace applications require household information including size, income estimate, citizenship or immigration status, and Social Security numbers to determine eligibility for plans and financial assistance.
Question 5: The SHOP (Small Business Health Options Program) Marketplace is designed for:
- Self-employed individuals without employees
- Small employers with generally 1–50 employees (Correct answer)
- Nonprofit organizations with any number of employees
- Large employers seeking alternative coverage options
Correct answer: Small employers with generally 1–50 employees
SHOP is the ACA Marketplace for small businesses, generally those with 1–50 full-time equivalent employees, allowing them to offer employees a choice of QHPs.
Question 6: A Certified Application Counselor (CAC) differs from a Navigator primarily because CACs are:
- Paid by insurance companies
- Certified by CMS-approved organizations (such as hospitals or community clinics) rather than federally funded (Correct answer)
- Only authorized to assist with Medicaid applications
- Required to hold a state insurance license
Correct answer: Certified by CMS-approved organizations (such as hospitals or community clinics) rather than federally funded
CACs are trained and certified through CMS-approved organizations such as hospitals, FQHCs, and community centers, while Navigators receive federal grant funding.
CES Marketplace and Exchange Navigation 1
What is the primary role of the Health Insurance Marketplace created by the ACA?