CES Premium and Cost-Sharing 1 — Questions and Answers
Question 1: The advance premium tax credit (APTC) is based on the cost of which benchmark plan?
- Lowest-cost Bronze plan
- Second-lowest-cost Silver plan (Correct answer)
- Lowest-cost Gold plan
- Lowest-cost plan available in the area
Correct answer: Second-lowest-cost Silver plan
APTC is calculated based on the premium of the second-lowest-cost Silver plan available to the household in their area.
Question 2: Cost-sharing reductions (CSR) on the ACA Marketplace are only available to those who enroll in:
- Any Marketplace plan
- A Bronze plan
- A Silver plan (Correct answer)
- A Gold or Platinum plan
Correct answer: A Silver plan
CSRs are only applied to Silver plans; eligible individuals with incomes between 100–250% FPL must enroll in a Silver plan to receive the enhanced benefits.
Question 3: For 2025, the ACA out-of-pocket maximum for an individual in a non-grandfathered plan is approximately:
- $5,000
- $7,000
- $9,200 (Correct answer)
- $12,000
Correct answer: $9,200
The ACA sets annual out-of-pocket maximum limits that are adjusted each year; for 2025, the individual limit is $9,200 and family limit is $18,400.
Question 4: Which income level (as a percentage of the Federal Poverty Level) qualifies for advance premium tax credits in the ACA Marketplace?
- 100–200% FPL
- 100–250% FPL
- 100–400% FPL (Correct answer)
- 138–400% FPL
Correct answer: 100–400% FPL
Under current law (extended through 2025), individuals with incomes between 100% and 400% FPL—and above 400% FPL if unaffordable—may qualify for APTCs.
Question 5: If an enrollee chooses a plan other than the benchmark Silver plan, the APTC amount:
- Increases to match the chosen plan's premium
- Stays the same regardless of which plan is selected (Correct answer)
- Is reduced by 10% for non-Silver plans
- Is only applicable to Silver plans
Correct answer: Stays the same regardless of which plan is selected
The APTC amount is fixed based on the benchmark Silver plan and applied to whichever plan the enrollee selects, covering more of a less expensive plan or less of a more expensive one.
Question 6: What is the 'family glitch' that was fixed by IRS rules effective 2023?
- Dependents could not be added mid-year to employer plans
- Affordability of employer coverage was measured only against the employee's premium, not the family cost (Correct answer)
- Children over 18 could not remain on parents' plans
- Spouses were excluded from premium tax credit calculations
Correct answer: Affordability of employer coverage was measured only against the employee's premium, not the family cost
The family glitch referred to the rule that employer coverage was deemed 'affordable' based only on the employee-only premium, leaving dependent family members ineligible for Marketplace subsidies.
CES Premium and Cost-Sharing 1
The advance premium tax credit (APTC) is based on the cost of which benchmark plan?