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Eligibility and Enrollment 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 Eligibility and Enrollment flashcards as text

  1. What is the income range for eligibility to receive Advance Premium Tax Credits (APTC) in most states?

    Answer: 100%–400% FPL

    APTCs are generally available to individuals and families with MAGI between 100% and 400% FPL (the ARP temporarily extended this, but the standard rule is 100–400%).

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

    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.

  3. Which of the following life events qualifies as a Special Enrollment Period trigger?

    Answer: Getting married

    Marriage is a qualifying life event that triggers a 60-day Special Enrollment Period to enroll in or change Marketplace coverage.

  4. CHIP provides coverage for children in families up to what income level in most states?

    Answer: At least 200% FPL, with many states higher

    Federal law requires states to cover children in CHIP up to at least 200% FPL, and many states set their thresholds significantly higher.

  5. A consumer enrolled in a Silver plan wants to change to a Gold plan in February. What must be true for this change to be allowed?

    Answer: She must have a Special Enrollment Period qualifying event

    Outside of Open Enrollment, plan changes are only permitted when a consumer has a qualifying SEP life event.

  6. When a consumer reports income changes during the plan year, what should a CAC advise?

    Answer: Report changes promptly to avoid large tax repayment or missed savings

    Reporting income changes promptly helps consumers receive accurate APTCs and avoids large reconciliation payments or foregone subsidies at tax time.

  7. Which population is automatically enrolled in Medicare Part A at age 65 without an application?

    Answer: Those already receiving Social Security or Railroad Retirement Board benefits

    Individuals already collecting Social Security or RRB benefits are automatically enrolled in Medicare Part A and B when they turn 65.