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Eligibility and Enrollment Process 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 Process flashcards as text

  1. For Marketplace eligibility, Modified Adjusted Gross Income (MAGI) is used to calculate household income. Which income type is included in MAGI?

    Answer: Social Security benefits that are taxable

    Taxable Social Security benefits are included in MAGI, while SSI, child support received, and gifts are excluded.

  2. A family of four has a projected annual income of 180% FPL. Which program are they most likely eligible for?

    Answer: Medicaid or CHIP depending on state expansion status

    At 180% FPL, this family falls within Medicaid or CHIP eligibility thresholds in most states (Medicaid for adults in expansion states, CHIP for children).

  3. What is the upper income limit for premium tax credit (APTC) eligibility under the ACA through 2025?

    Answer: No upper income limit through 2025 under the enhanced subsidies

    Under the American Rescue Plan Act extensions, enhanced APTCs have no upper income cap through 2025, meaning even higher-income consumers may qualify.

  4. Which household members must be included when calculating household size for Marketplace eligibility?

    Answer: The tax filer, spouse, and all tax dependents

    Marketplace household size is based on the tax household: the filer, spouse, and all claimed tax dependents.

  5. A 25-year-old is claimed as a tax dependent by her parents but wants to enroll in her own Marketplace plan. What happens to her eligibility?

    Answer: Her eligibility is based on her parents' household income

    If someone is claimed as a tax dependent, their Marketplace eligibility is assessed based on the claiming household's income and size.

  6. Cost-sharing reductions (CSRs) are available to consumers who enroll in which plan metal tier?

    Answer: Silver plans only

    CSRs are only available when consumers enroll in a Silver plan; they reduce deductibles, copays, and out-of-pocket maximums.

  7. A consumer estimates she will earn 95% FPL this year. She applies for Marketplace coverage. What should the CAC advise?

    Answer: Apply for Medicaid since she is under 100% FPL

    In states that have expanded Medicaid, adults with income under 138% FPL are directed to Medicaid rather than Marketplace subsidies.