Ethics and Impartiality Flashcards

A CAC is helping a client who qualifies for both Medicaid and a Marketplace plan with subsidies. The client asks which is better. What is the ethical approach?

Answer: Explain both options objectively and let the client decide based on their needs

CACs must present all eligible coverage options impartially so clients can make informed decisions that suit their individual circumstances.

A CAC discovers during an enrollment session that a client's employer offers coverage that may be considered affordable under ACA rules. What should the CAC do?

Answer: Inform the client about the employer offer and explain how it may affect subsidy eligibility

CACs must inform clients of facts that affect their eligibility, including the impact of affordable employer coverage on Marketplace subsidies.

Which of the following actions would constitute a conflict of interest for a CAC?

Answer: Receiving a commission from an insurer for enrolling clients in their plans

Receiving financial compensation from insurers for enrollments creates a conflict of interest that compromises the CAC's required impartiality.

A client asks a CAC to recommend the plan with the lowest monthly premium without considering other cost-sharing factors. What is the most ethical response?

Answer: Explain that total costs include deductibles and copays, then help the client compare all cost factors

Ethical CAC practice requires ensuring clients have complete cost information, including deductibles and out-of-pocket maximums, not just premiums.

Under CAC ethical standards, how should a CAC handle a situation where they are not able to answer a client's complex tax question related to the premium tax credit?

Answer: Acknowledge the limitation and refer the client to a tax professional or IRS resources

CACs must operate within their scope of expertise and refer clients to appropriate professionals when questions exceed that scope.

A CAC's employer instructs them to prioritize enrolling clients in a specific health plan. How should the CAC respond?

Answer: Report the instruction to CMS as a potential compliance violation

Instructions to steer clients to specific plans violate CAC impartiality requirements and should be reported to CMS as a compliance concern.

A client shares information during enrollment that suggests potential eligibility fraud. What is the CAC's ethical obligation?

Answer: Assist the client in accurately reporting their information and advise against false statements

CACs must assist clients in providing accurate information and must not facilitate or ignore potential fraud during the enrollment process.