Consumer Education and Assistance Flashcards

A 26-year-old consumer was dropped from their parent's employer-sponsored plan on their birthday. What type of coverage event does this represent for Marketplace purposes?

Answer: An involuntary loss of minimum essential coverage that qualifies for a SEP

Aging off a parent's plan at 26 is an involuntary loss of minimum essential coverage that qualifies the individual for a 60-day Special Enrollment Period.

A consumer is considering a Catastrophic health plan. A CAC should inform them that Catastrophic plans are only available to individuals who:

Answer: Are under 30 or have a hardship or affordability exemption

Catastrophic plans are limited to people under 30 years old or those who qualify for a hardship or affordability exemption.

When helping a consumer understand the Summary of Benefits and Coverage (SBC), a CAC should explain that the SBC is designed to:

Answer: Provide a standardized, easy-to-read summary so consumers can compare plans consistently

The SBC is a standardized document required by the ACA that allows consumers to compare plans using consistent, easy-to-understand information.

A consumer is concerned about medical debt from before their Marketplace enrollment. A CAC should clarify that Marketplace coverage:

Answer: Only covers services received on or after the plan's effective date

Marketplace health plans only cover medical services received on or after the plan's coverage effective date and do not cover prior medical expenses.

A CAC discovers a consumer has been enrolled in both Medicaid and a Marketplace plan with APTC at the same time. The correct action is to:

Answer: Help the consumer terminate the Marketplace plan since Medicaid provides minimum essential coverage

Consumers eligible for Medicaid should be enrolled in Medicaid and should not simultaneously receive APTC for a Marketplace plan; the CAC should help correct the overlap.

A consumer wants to know whether dental coverage is included in their Marketplace health plan. A CAC should explain that:

Answer: Dental coverage for adults is generally not included in health plans and must be purchased separately

Adult dental coverage is not an essential health benefit and is typically not included in Marketplace health plans; consumers must purchase a separate stand-alone dental plan.

A consumer reports they moved to a new state and wants to know if their current Marketplace plan will follow them. A CAC should explain:

Answer: The consumer must enroll in a new Marketplace plan in their new state, as plans are state-specific

Marketplace plans are state-specific, so moving to a new state triggers a SEP to enroll in a plan through the new state's Marketplace.