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
A self-employed consumer's income varies month to month. How should a CAC advise them to report income on the Marketplace application?
Answer: Report their best estimate of projected annual household income
The Marketplace uses projected annual household income, so self-employed applicants should provide their best estimate for the coverage year.
An employer offers a health plan that is considered unaffordable under ACA standards. What does this mean for the employee's Marketplace eligibility?
Answer: The employee may qualify for APTC even if they have access to employer coverage
If the employer's lowest-cost self-only plan exceeds the ACA affordability threshold, the employee may qualify for Marketplace APTC.
COBRA continuation coverage is considered minimum essential coverage. How does this affect a consumer's Marketplace SEP eligibility when COBRA ends?
Answer: Losing COBRA triggers a 60-day SEP like any qualifying loss of coverage
When COBRA coverage ends or becomes unaffordable, it is treated as a loss of qualifying coverage, triggering a 60-day SEP.
A consumer enrolled in a Marketplace plan is later found to be eligible for Medicaid. What should happen to their Marketplace enrollment?
Answer: Their Marketplace plan is terminated and they transition to Medicaid
Medicaid eligibility supersedes Marketplace enrollment; the consumer transitions to Medicaid and loses Marketplace APTC eligibility.
A consumer wants to change from a Silver plan to a Gold plan outside Open Enrollment. Under what circumstance is this allowed?
Answer: Only if they have a qualifying life event that triggers a SEP
Plan changes outside Open Enrollment are only permitted when a consumer has a qualifying life event that triggers a Special Enrollment Period.
What is the role of the Federally Facilitated Marketplace (FFM) in states that did not set up their own exchange?
Answer: It operates the Marketplace for plan comparison, enrollment, and eligibility determination
The FFM, operated by CMS, runs the Marketplace in states without a State-Based Marketplace, handling plan shopping, eligibility, and enrollment.
A consumer in a non-Medicaid-expansion state has income at 75% FPL. What coverage options are available to them?
Answer: They fall in the coverage gap and may have no subsidized options
In non-expansion states, adults below 100% FPL don't qualify for Medicaid (for adults) or Marketplace APTCs, leaving them in the 'coverage gap' with no subsidized option.