Consumer Education and Assistance Flashcards
7 cards from real CACS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Consumer Education and Assistance flashcards as text
A consumer asks a CAC about the difference between a premium tax credit and a cost-sharing reduction. Which statement best describes cost-sharing reductions (CSRs)?
Answer: CSRs lower out-of-pocket costs like deductibles, copays, and coinsurance
Cost-sharing reductions lower out-of-pocket costs such as deductibles, copayments, and coinsurance, and are only available on Silver plans for eligible consumers.
A consumer who is newly employed wants to enroll in Marketplace coverage outside of Open Enrollment. Which qualifying life event would make them eligible for a Special Enrollment Period?
Answer: Starting a new job that does not offer employer-sponsored insurance
Losing or gaining access to job-based coverage is a qualifying life event that triggers a Special Enrollment Period.
When educating a consumer about the Marketplace's metal tiers, a CAC should explain that actuarial value (AV) represents:
Answer: The percentage of covered medical costs the plan pays on average for the standard population
Actuarial value is the average percentage of covered health care costs the plan pays for a standard population, with higher AV meaning lower average out-of-pocket costs.
A consumer reports they received a notice that their income-based Medicaid was terminated due to a change in state policy. As a CAC, your first recommended action is to:
Answer: Advise them to appeal the termination through the Medicaid agency before seeking alternatives
Consumers should first be advised to appeal a Medicaid termination through the state Medicaid agency, as reinstatement may be possible before pursuing other options.
Which of the following best describes the role of a CAC when helping a consumer compare health plans?
Answer: Presenting objective information about plan options so the consumer can make an informed choice
CACs must present objective, unbiased information about all available plan options and let the consumer make the final decision.
A consumer asks if their undocumented family members can enroll in Marketplace coverage. A CAC should explain that:
Answer: Undocumented individuals are not eligible to enroll in Marketplace or Medicaid coverage
Undocumented individuals are not eligible to enroll in Marketplace plans or Medicaid, though some states provide limited emergency coverage.
A consumer is confused about the Notice of Premium Tax Credit Eligibility they received after submitting a Marketplace application. As a CAC, you should explain this notice means:
Answer: They qualify for financial assistance and can shop for plans with that credit applied
An eligibility notice confirming premium tax credit eligibility means the consumer can shop for Marketplace plans and apply the credit to reduce monthly premiums.