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
A consumer receiving unemployment compensation in 2021 or later signs up for Marketplace coverage. What special provision applies?
Answer: They may qualify for a full premium subsidy (benchmark plan at $0) under unemployment SEP rules
Under the American Rescue Plan, consumers receiving unemployment compensation in 2021 (and subsequent legislative extensions) were eligible for enhanced APTCs reducing their benchmark Silver plan premium to $0.
A consumer's immigration status is 'Deferred Action for Childhood Arrivals' (DACA). What is their Marketplace eligibility?
Answer: Not eligible for Marketplace enrollment
DACA recipients are not considered 'lawfully present' under federal ACA rules and are therefore not eligible to enroll in Marketplace plans (though some states have separate programs).
Which of the following is NOT considered a qualifying health plan (QHP) for ACA purposes?
Answer: Short-term limited duration health insurance
Short-term limited duration insurance (STLDI) is explicitly excluded from the definition of a QHP and does not provide minimum essential coverage.
A consumer turns 26 and is dropped from a parent's health plan on their birthday. How long do they have to enroll in their own Marketplace plan?
Answer: 60 days
Losing coverage due to aging off a parent's plan is a qualifying life event, giving the consumer 60 days to enroll in a Marketplace plan via an SEP.
The annual Open Enrollment Period for Marketplace coverage in most states typically runs from:
Answer: November 1 – January 15 (or January 31 in some states)
The standard federal OEP runs November 1 through January 15, though some state-based Marketplaces extend their deadlines further.
A CAC is helping a consumer whose income fluctuates between 90% and 160% FPL from year to year. What key advice should the CAC provide?
Answer: Estimate income carefully and report changes promptly to ensure correct program placement and avoid subsidy reconciliation issues
For consumers with fluctuating income, accurate income projection and timely reporting of changes are critical to ensure they receive the correct benefits and avoid owing money at tax time.
An employer offers coverage to a worker but not to the worker's spouse. The spouse's income is 200% FPL. What is the spouse's eligibility for Marketplace subsidies?
Answer: Eligible for APTC because the offer does not extend to the spouse
If employer coverage is only offered to the employee and not the spouse, the spouse is not considered to have access to ESI and may be eligible for APTC through the Marketplace.