Certified Application Counselor (CAC) Certification Exam — Questions and Answers

Question 1: A client who is a seasonal agricultural worker has inconsistent income throughout the year. The CAC should advise them to report:

Their projected annual income, and to report income changes throughout the year to avoid reconciliation issues at tax time (Correct answer)
Only their highest monthly income to ensure they get the minimum premium tax credit
Zero income since farm work is often paid in cash
Last year's tax return income even if this year is expected to be very different

Correct answer: Their projected annual income, and to report income changes throughout the year to avoid reconciliation issues at tax time

Clients should report expected annual income and update the Marketplace when income changes significantly to avoid large premium tax credit repayments or underpayments at tax filing.

Question 2: A CAC overhears a colleague casually discussing a consumer's income and immigration status in a public waiting room. What should the CAC do?

File a complaint with HHS Office for Civil Rights
Ignore it since the colleague likely has authorization to discuss the case
Ask the consumer if they mind their information being shared
Intervene immediately to stop the discussion and report the incident to a supervisor (Correct answer)

Correct answer: Intervene immediately to stop the discussion and report the incident to a supervisor

CACs have an obligation to protect consumer privacy; overhearing an unauthorized disclosure requires immediate intervention and internal reporting.

Question 3: When assisting consumers, a CAC is responsible for safeguarding their Personally Identifiable Information (PII). Which of the following is the BEST example of PII that must be protected?

The consumer's opinion on available health plans.
The consumer's name combined with their Social Security Number. (Correct answer)
A list of hospitals in the consumer's local area.
An anonymized statistic about Marketplace enrollment in their state.

Correct answer: The consumer's name combined with their Social Security Number.

Personally Identifiable Information (PII) is any information that can be used to distinguish or trace an individual's identity. A name combined with a Social Security Number is a primary example of sensitive PII that requires the highest level of protection. The other options are either opinions, public information, or anonymized data.

Question 4: A consumer wants to know if a specific drug is covered before enrolling in a Marketplace plan. Which plan document should the CAC direct them to review?

Summary of Benefits and Coverage (SBC)
Explanation of Benefits (EOB)
Plan Formulary (Correct answer)
Certificate of Coverage

Correct answer: Plan Formulary

The plan formulary lists all covered prescription drugs and their tier-based cost-sharing, making it the correct resource for checking drug coverage.

Question 5: A consumer wants their CAC to help them understand their Explanation of Benefits (EOB). Under what condition may the CAC view this document?

Only if the consumer is present and explicitly shares the document with the CAC (Correct answer)
Only with a court order
Anytime, since EOBs are not protected health information
Only after obtaining a signed HIPAA authorization from the consumer's insurer

Correct answer: Only if the consumer is present and explicitly shares the document with the CAC

EOBs contain PHI, so a CAC may only review them when the consumer voluntarily shares the document and consents to assistance in the moment.

Question 6: A client who recently obtained a green card asks whether they can enroll in a Marketplace plan. What is the correct response?

Green card holders are lawfully present and may enroll in Marketplace plans (Correct answer)
They must wait five years before applying for any health coverage
Green card holders are not eligible for Marketplace coverage
Only U.S. citizens may use the Marketplace

Correct answer: Green card holders are lawfully present and may enroll in Marketplace plans

Lawfully permanent residents (green card holders) are considered lawfully present and are eligible to enroll in Marketplace plans.

Question 7: Cost-Sharing Reductions (CSRs) under the ACA are ONLY available with which metal tier plan?

Bronze
Silver (Correct answer)
Gold
Any metal tier

Correct answer: Silver

CSRs are only applied to Silver plans; eligible individuals must enroll in a Silver plan to receive reduced deductibles, copays, and out-of-pocket maximums.

Question 8: Which document is essential to provide to consumers when assisting with coverage options?

The provider’s internal policies.
The IRS tax filing guide.
The Summary of Benefits and Coverage (SBC) (Correct answer)
A glossary of insurance terms only.

Correct answer: The Summary of Benefits and Coverage (SBC)

The Summary of Benefits and Coverage (SBC) is a standardized document required by the Affordable Care Act (ACA) that provides a clear, concise summary of a health plan's benefits and coverage. It helps consumers compare different plans side-by-side by outlining costs, covered services, and limitations in an easy-to-understand format. Providing the SBC ensures transparency and empowers consumers to make informed decisions about their health insurance options.

Question 9: A CAC is approached by a client who wants help switching plans mid-year without a qualifying life event. What is the ethical response?

Explain that mid-year plan changes require a qualifying life event and outline what qualifies (Correct answer)
Help the client switch plans since customer satisfaction is the priority
Submit a SEP application and let the Marketplace determine eligibility
Tell the client to contact the insurer directly since the CAC cannot help

Correct answer: Explain that mid-year plan changes require a qualifying life event and outline what qualifies

CACs must accurately explain enrollment rules including that mid-year plan changes require a qualifying life event, even when the client wants otherwise.

Question 10: A client's primary language is Somali and no interpreter is immediately available. What is the best immediate action?

Ask a random bilingual staff member from another department to interpret
Send the client written materials in English and ask them to return when they understand them
Reschedule the appointment and arrange a qualified Somali interpreter for the next session (Correct answer)
Proceed with the enrollment using gestures and pictures

Correct answer: Reschedule the appointment and arrange a qualified Somali interpreter for the next session

When a qualified interpreter is not available, rescheduling to ensure proper language access is better than proceeding without effective communication.

Question 11: Which scenario BEST illustrates proper use of a consumer's immigration status information collected during enrollment?

Using it solely to determine eligibility for Marketplace coverage and APTC/CSR (Correct answer)
Providing it to the consumer's employer upon request
Including it in outreach reports to community partners to improve targeting
Sharing it with a local school district to verify a child's enrollment eligibility

Correct answer: Using it solely to determine eligibility for Marketplace coverage and APTC/CSR

Immigration status collected during enrollment may only be used to determine eligibility for the specific program — it cannot be shared for other purposes.

Question 12: A consumer enrolled in a Silver plan receives Cost-Sharing Reductions. What happens if they switch to a Gold plan mid-year through a SEP?

CSRs transfer automatically to the Gold plan
They must reapply for CSRs with CMS
They lose CSR benefits, since CSRs only apply to Silver plans (Correct answer)
CSR amounts increase on a Gold plan

Correct answer: They lose CSR benefits, since CSRs only apply to Silver plans

CSRs are only available on Silver plans; switching to any other metal tier eliminates access to cost-sharing reduction benefits.

Question 13: What is 'guaranteed issue' under the ACA?

A guarantee of government subsidies for all applicants
The assurance that all claims will be paid
The guarantee that premiums will not increase
The requirement that insurers must accept all applicants regardless of health status (Correct answer)

Correct answer: The requirement that insurers must accept all applicants regardless of health status

Guaranteed issue means health insurers must offer and sell coverage to any applicant who applies during open or special enrollment, regardless of pre-existing conditions.

Question 14: Which of the following is a key role of a Certified Application Counselor (CAC)?

Selling insurance plans on behalf of private companies.
Determining a consumer's final tax liability for the Premium Tax Credit.
Helping consumers understand their eligibility for Marketplace plans, Medicaid, and CHIP. (Correct answer)
Recommending a specific insurance plan to a consumer.

Correct answer: Helping consumers understand their eligibility for Marketplace plans, Medicaid, and CHIP.

The primary role of a CAC is to provide fair, impartial, and accurate information to help consumers understand their options and assist them with the application process for Marketplace coverage, Medicaid, and the Children's Health Insurance Program (CHIP). They are not permitted to sell insurance or recommend specific plans.

Question 15: A state agency contacts a CAC requesting information about a specific consumer's enrollment status. The CAC should:

Verify the request is legitimate and check whether a valid data-sharing agreement or consumer consent exists before disclosing (Correct answer)
Decline all state agency requests as outside the scope of CAC duties
Ask the consumer first, then provide the information without further verification
Provide the information since state agencies are authorized recipients

Correct answer: Verify the request is legitimate and check whether a valid data-sharing agreement or consumer consent exists before disclosing

Even government agencies must have proper legal authority or consumer consent before a CAC can disclose information; the CAC must verify legitimacy first.

Question 16: Which of the following is a fundamental requirement for an individual to be eligible to enroll in a Qualified Health Plan through the Health Insurance Marketplace?

They must be employed full-time.
They must not be incarcerated. (Correct answer)
They must have a pre-existing medical condition.
They must be eligible for Medicare Part A.

Correct answer: They must not be incarcerated.

To be eligible to enroll in health coverage through the Marketplace, an individual must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated. Individuals enrolled in Medicare are not eligible to purchase a Marketplace plan.

Question 17: Under the ACA's privacy rules, which federal law primarily governs the protection of personally identifiable information (PII) collected during the Health Insurance Marketplace enrollment process?

FERPA
HIPAA
The ACA itself and its implementing regulations (Correct answer)
The Privacy Act of 1974

Correct answer: The ACA itself and its implementing regulations

The ACA and its implementing regulations, including 45 CFR Part 155, govern privacy protections for PII collected during Marketplace enrollment.

Question 18: A client who recently became a U.S. citizen through naturalization asks when they can enroll in a Marketplace plan. The CAC should tell them:

They can only enroll during the next Open Enrollment Period
They must wait 90 days before they can apply as a citizen
Naturalization does not affect Marketplace eligibility
Becoming a U.S. citizen is a qualifying life event that triggers a Special Enrollment Period (Correct answer)

Correct answer: Becoming a U.S. citizen is a qualifying life event that triggers a Special Enrollment Period

Gaining citizenship is a qualifying life event that triggers a 60-day Special Enrollment Period, allowing immediate enrollment outside Open Enrollment.

Question 19: A Marketplace plan's Summary of Benefits and Coverage (SBC) is required to be provided:

Only for plans with a deductible over $1,000
Automatically before enrollment and upon request (Correct answer)
Only after the consumer has been enrolled for 30 days
Only upon written request from the consumer

Correct answer: Automatically before enrollment and upon request

The ACA requires insurers to provide an SBC automatically before enrollment and upon request to help consumers compare plan options.

Question 20: Which of the following actions would constitute a conflict of interest for a CAC?

Helping a client compare two different insurance carriers
Assisting a client who is a family member
Explaining premium tax credit calculations to a client
Receiving a commission from an insurer for enrolling clients in their plans (Correct answer)

Correct answer: Receiving a commission from an insurer for enrolling clients in their plans

Receiving financial compensation from insurers for enrollments creates a conflict of interest that compromises the CAC's required impartiality.

Question 21: Which of the following is a permitted use of consumer information collected by a CAC?

Using consumer data to conduct follow-up outreach regarding their enrollment status (Correct answer)
Providing a consumer's income details to an employer upon request
Sharing consumer contact information with a partner organization's fundraising department
Selling anonymized consumer data to a health insurance company

Correct answer: Using consumer data to conduct follow-up outreach regarding their enrollment status

CACs may use consumer contact information to conduct follow-up related to the enrollment assistance they provided, as this is within the scope of the original purpose.

Question 22: A family of four with an income of 200% FPL applies for coverage. Which program should they FIRST be screened for?

Medicare
Medicaid and CHIP before Marketplace plans (Correct answer)
Only Marketplace plans with APTC
Short-term health plans

Correct answer: Medicaid and CHIP before Marketplace plans

CACs must screen all applicants for Medicaid and CHIP eligibility first, as these programs may provide more comprehensive and cost-effective coverage.

Question 23: What happens to a consumer's premium tax credit if their actual income at year-end is higher than they estimated during enrollment?

The IRS forgives the excess credit automatically
The insurance company refunds the difference
They may owe repayment of excess credits when filing taxes (Correct answer)
Their coverage is terminated immediately

Correct answer: They may owe repayment of excess credits when filing taxes

If a consumer received more APTC than their actual income supports, they must repay some or all of the excess when filing their federal income tax return.

Question 24: Which federal agency administers the Health Insurance Marketplace (Healthcare.gov)?

Office of Personnel Management
Centers for Medicare & Medicaid Services (CMS) (Correct answer)
Social Security Administration
Department of Labor

Correct answer: Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS), within HHS, operates the federally facilitated Marketplace at Healthcare.gov.

Question 25: A former consumer contacts a CAC organization requesting that their records be deleted. What is the organization's correct response?

Deny the request without explanation
Transfer the records to a third party before deleting the organization's copy
Delete all records immediately upon request
Inform the consumer that records must be retained per federal requirements but explain their rights under applicable law (Correct answer)

Correct answer: Inform the consumer that records must be retained per federal requirements but explain their rights under applicable law

Federal record retention requirements may obligate the organization to retain records for a specified period regardless of deletion requests, though consumers must be informed of their rights.

Question 26: What is a Special Enrollment Period (SEP)?

A period triggered by a qualifying life event (Correct answer)
A yearly health exam.
An insurance checkup by employers.
A reminder to renew car insurance.

Correct answer: A period triggered by a qualifying life event

A Special Enrollment Period (SEP) is a specific timeframe outside of the annual Open Enrollment Period during which individuals can enroll in or change a health insurance plan. This period is exclusively triggered by certain qualifying life events, such as marriage, birth of a child, loss of other health coverage, or a permanent move, allowing people to get coverage when their circumstances change unexpectedly.

Question 27: Which federal law made it illegal for health insurers to impose lifetime dollar limits on essential health benefits?

HIPAA
COBRA
The Employee Retirement Income Security Act (ERISA)
The Affordable Care Act (ACA) (Correct answer)

Correct answer: The Affordable Care Act (ACA)

The ACA banned lifetime and unreasonable annual dollar limits on essential health benefits in all non-grandfathered health plans.

Question 28: Which of the following is a critical element that must be included in a consumer's written consent form before a CAC can access and use their PII?

The CAC's personal contact information.
The timeframe during which the consent is valid. (Correct answer)
The name of the consumer's preferred health insurance plan.
A clause allowing the CAC to share the PII for marketing purposes.

Correct answer: The timeframe during which the consent is valid.

A valid consent agreement must specify the period during which the authorization is effective, and it must also allow the consumer to revoke the consent at any time. This ensures the consumer has control over their information. Using PII for marketing is prohibited, and while other details might be on the form, the timeframe of consent is a required component.

Question 29: When working with a client who has experienced domestic violence, the CAC should be aware that:

Domestic violence situations do not affect how the application is completed
The CAC should contact the abuser to verify household information
Survivors may be able to enroll in a separate household from the abuser even if legally married, and special provisions may apply (Correct answer)
Survivors must include the abuser's income on their application if they are legally married and living together

Correct answer: Survivors may be able to enroll in a separate household from the abuser even if legally married, and special provisions may apply

Marketplace rules allow domestic violence survivors to apply as a separate household and may have special enrollment or income-reporting provisions.

Question 30: What does 'creditable coverage' mean in the context of the ACA and Special Enrollment Periods?

Prior health insurance that counts toward satisfying waiting periods (Correct answer)
A plan with a credit score requirement
Coverage that includes dental and vision
Coverage that is free of charge

Correct answer: Prior health insurance that counts toward satisfying waiting periods

Creditable coverage refers to prior qualifying health coverage that may be used to satisfy enrollment requirements and avoid gaps triggering penalties.

Question 31: Under the ACA, what is the maximum out-of-pocket limit for an individual in a Marketplace plan for plan year 2024?

$12,000
$7,000
$9,450 (Correct answer)
$5,000

Correct answer: $9,450

For 2024, the ACA out-of-pocket maximum for individual coverage is $9,450; once reached, the plan pays 100% of covered in-network costs.

Question 32: A CAC assists consumers at a community event where multiple booths are set up in close proximity. What is the MOST important privacy precaution to take?

Use a loud voice so the consumer can hear clearly over background noise
Photograph each consumer's documents for faster processing
Ask neighboring booth operators to sign non-disclosure agreements
Collect only names and phone numbers at the event and complete full applications later in a private setting (Correct answer)

Correct answer: Collect only names and phone numbers at the event and complete full applications later in a private setting

Collecting sensitive PII in a public, non-private setting creates unacceptable privacy risks; limiting data collection to non-sensitive items and completing full applications privately is the correct approach.

Question 33: During an enrollment event, a CAC collects personally identifiable information (PII) from several consumers on paper forms. What is a key responsibility of the CAC regarding this information?

Enter the information into their personal, password-protected laptop for convenience.
Leave the forms on their desk until they have time to enter the data.
Ensure the information is stored and transmitted securely, according to privacy and security standards. (Correct answer)
Share the information with colleagues who might also be able to help the consumers.

Correct answer: Ensure the information is stored and transmitted securely, according to privacy and security standards.

CACs and their organizations must adhere to strict privacy and security standards to protect consumer's PII. This includes developing and utilizing secure methods for collecting, storing, and transmitting sensitive information. Leaving documents unsecured or using personal devices would be a violation of these standards.

Question 34: Which statement about Marketplace plan formularies is accurate?

Formularies are only required for Gold and Platinum plans
Each plan has its own formulary, and drug coverage and cost-sharing can vary significantly between plans (Correct answer)
Prescription drugs are not covered under any metal tier except Platinum
All plans on the Marketplace must cover the same exact drugs at the same cost

Correct answer: Each plan has its own formulary, and drug coverage and cost-sharing can vary significantly between plans

Each insurer sets its own formulary, so the drugs covered and their tier-based cost-sharing can differ substantially between plans even within the same metal tier.

Question 35: Which of the following best describes the role of a CAC when a consumer experiences a qualifying life event?

Automatically enroll the consumer in the lowest-cost plan
Notify the IRS of the consumer's change in status
File a complaint with CMS on the consumer's behalf
Help the consumer understand their SEP eligibility and assist with enrollment (Correct answer)

Correct answer: Help the consumer understand their SEP eligibility and assist with enrollment

A CAC's role is to help consumers understand their SEP options and assist them in navigating the enrollment process.

Question 36: What is the primary electronic resource the Marketplace uses to verify an applicant's income during the application process?

Employer payroll systems accessed directly
Consumer credit bureau reports
Federal Data Services Hub connecting to IRS and SSA records (Correct answer)
State Department of Motor Vehicles database

Correct answer: Federal Data Services Hub connecting to IRS and SSA records

The Federal Data Services Hub connects the Marketplace to IRS, Social Security Administration, and other federal databases to electronically verify income and other eligibility data.

Question 37: A CAC is assisting a client from a cultural background where discussing finances openly is uncomfortable. What is the ethical approach?

Explain why income information is required and assure the client of privacy protections (Correct answer)
Estimate income based on the client's appearance
Refer the client elsewhere since the session cannot proceed
Skip income questions to respect the client's culture

Correct answer: Explain why income information is required and assure the client of privacy protections

CACs must explain the necessity and confidentiality of required information while remaining culturally sensitive, never skipping required fields.

Question 38: When calculating Modified Adjusted Gross Income (MAGI) household income for Marketplace eligibility, which type of income MUST be included?

Workers' compensation settlements
Gifts received from family members
Tax-exempt Social Security benefits received by the tax filer (Correct answer)
Child support payments received

Correct answer: Tax-exempt Social Security benefits received by the tax filer

Tax-exempt Social Security income must be added back into MAGI for Marketplace eligibility calculations, even though it is excluded from regular taxable income.

Question 39: A consumer who speaks only Vietnamese comes to an appointment with her 16-year-old son, who is fluent in English and offers to interpret. According to best practices for language access, what should the CAC do?

Politely decline the son's offer and connect with a professional telephonic interpretation service. (Correct answer)
Provide the consumer with Vietnamese-language forms to complete on their own time.
Use the son as the interpreter to complete the application quickly and efficiently.
Reschedule the appointment for a time when a professional in-person interpreter can be present.

Correct answer: Politely decline the son's offer and connect with a professional telephonic interpretation service.

Language assistance services must be provided free of charge, be accurate, and protect the consumer's privacy. Using a minor family member as an interpreter is strongly discouraged because it can compromise confidentiality, introduce errors in complex terminology, and place the child in an inappropriate role. The required standard is to use a qualified, professional interpreter, which can be provided effectively via telephone.

Question 40: A consumer is offered employer-sponsored insurance (ESI) that costs 12% of household income. How does this affect their Marketplace subsidy eligibility?

They are ineligible for APTC because the offer meets minimum value
Employer coverage never affects Marketplace eligibility
They can choose Marketplace but will lose all subsidies
They are still eligible for APTC because the offer is unaffordable (Correct answer)

Correct answer: They are still eligible for APTC because the offer is unaffordable

If the employee-only ESI premium exceeds the ACA's affordability threshold (roughly 9.02–9.12% of household income depending on the year), the offer is considered unaffordable and the consumer may qualify for APTC.

Question 41: How can a consumer receive the benefit of the Premium Tax Credit throughout the year?

By submitting a quarterly voucher to the IRS
As an advance payment applied directly to monthly premiums (APTC) (Correct answer)
Only as a lump sum refund at tax filing
Through a debit card issued by CMS

Correct answer: As an advance payment applied directly to monthly premiums (APTC)

Consumers can receive the Premium Tax Credit as an Advance Premium Tax Credit (APTC) paid directly to their insurer each month, lowering their premium payments.

Question 42: Which of the following is NOT considered personally identifiable information (PII) in the context of Marketplace enrollment?

The name of the insurance carrier a consumer enrolled in
The county in which the Marketplace operates (Correct answer)
Social Security Number
Date of birth

Correct answer: The county in which the Marketplace operates

A county name alone is publicly available geographic data and does not identify any individual consumer.

Question 43: Under the Affordable Care Act, most health plans must cover certain preventive services at no cost to the consumer. This means:

Only high-deductible health plans are required to offer free preventive care.
The consumer does not have to pay a copayment, coinsurance, or deductible for these services when received from an in-network provider. (Correct answer)
All medical services, including emergency care, are covered without cost-sharing.
The services are free regardless of whether the provider is in-network or out-of-network.

Correct answer: The consumer does not have to pay a copayment, coinsurance, or deductible for these services when received from an in-network provider.

The ACA requires most private health plans to cover a list of preventive services without any cost-sharing (copay, coinsurance, or deductible) when these services are delivered by a provider in the plan's network.

Question 44: Which of the following is a qualifying life event that triggers a Special Enrollment Period?

Moving to a new ZIP code or county that affects plan availability (Correct answer)
Not enrolling during Open Enrollment
Voluntarily dropping existing coverage
Deciding a current plan is too expensive

Correct answer: Moving to a new ZIP code or county that affects plan availability

Moving to a new coverage area that changes available plan options is a qualifying life event that triggers a 60-day SEP.

Question 45: A CAC receives a subpoena requesting consumer enrollment records. The CAC should:

Forward the subpoena to HHS and await instructions
Consult with their organization's legal counsel before releasing any information (Correct answer)
Inform the consumer and refuse to comply
Comply immediately to avoid legal penalties

Correct answer: Consult with their organization's legal counsel before releasing any information

A subpoena may or may not require disclosure depending on its scope and applicable law; the CAC must consult legal counsel before releasing any consumer records.

Question 46: A consumer is applying for coverage and reveals undocumented family members in the household. How should a CAC handle this information?

Note it prominently in the consumer file for future reference
Exclude undocumented members from the application to simplify processing
Report it to immigration authorities as required by federal law
Use it solely to correctly calculate household size and eligibility, keeping it strictly confidential (Correct answer)

Correct answer: Use it solely to correctly calculate household size and eligibility, keeping it strictly confidential

Immigration status information may only be used for eligibility determinations and is strictly protected — CACs are prohibited from reporting it to immigration enforcement.

Question 47: What is the actuarial value of a Platinum plan?

100%
80%
90% (Correct answer)
70%

Correct answer: 90%

Platinum plans have an actuarial value of 90%, meaning the insurer covers about 90% of covered medical costs on average.

Question 48: What is the maximum out-of-pocket (MOOP) limit designed to protect?

The insurer from excessive claims
The consumer from unlimited cost-sharing in a plan year (Correct answer)
The federal government from premium tax credit overuse
Providers from unpaid bills

Correct answer: The consumer from unlimited cost-sharing in a plan year

The MOOP cap limits how much a consumer pays in cost-sharing (deductibles, copays, coinsurance) in a plan year; after reaching it, the plan covers 100% of covered costs.

Question 49: Which plan type is ONLY available to people under age 30 or those who qualify for a hardship or affordability exemption?

Gold
Bronze
Catastrophic (Correct answer)
Silver

Correct answer: Catastrophic

Catastrophic plans are restricted to individuals under 30 or those who qualify for specific exemptions.

Question 50: Which document is generally NOT acceptable as proof of lawful presence for Marketplace enrollment?

Employment Authorization Document (EAD)
Temporary visitor visa with no work authorization (Correct answer)
Permanent Resident Card (green card)
Valid unexpired passport with an I-94 arrival record

Correct answer: Temporary visitor visa with no work authorization

A temporary visitor visa alone does not confer lawful presence status required for Marketplace eligibility; lawful presence requires specific immigration statuses.

Question 51: A CAC notices that a client's application may qualify them for CHIP for their children but a QHP for the adults. What should the CAC do?

Enroll the entire family in a QHP to simplify the process
Decline to assist with the children since CHIP is a separate program
Explain the options and help the family apply for both programs as appropriate (Correct answer)
Only enroll the adults in a QHP since that is the primary Marketplace product

Correct answer: Explain the options and help the family apply for both programs as appropriate

CACs must inform consumers of all coverage options for which they appear eligible and assist them in applying accordingly.

Certified Application Counselor (CAC) Certification Exam

The CMS Certified Application Counselor (CAC) exam certifies individuals to help consumers apply for and enroll in health coverage through the ACA Marketplace. It covers ACA law, marketplace plan options, eligibility, privacy and security standards, ethics, and serving diverse populations.

Questions

90 min

Time Limit

70%

To Pass

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