Eligibility Determination Process Flashcards
7 cards from real CEC 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 Determination Process flashcards as text
An applicant says they are enrolled in a health care sharing ministry. Does this constitute minimum essential coverage that would disqualify them from APTC?
Answer: No, health care sharing ministries are not MEC
Health care sharing ministries do not qualify as minimum essential coverage, so members may still be eligible for Marketplace plans and APTC.
A Marketplace consumer notifies the exchange of a new baby born during the plan year. What is the effective date of coverage for the newborn?
Answer: The date of birth
Newborns are covered from their date of birth when added to an existing Marketplace plan within the SEP window.
A consumer's annual household income is 250% FPL. They qualify for which level of cost-sharing reductions if they enroll in a Silver plan?
Answer: CSR variant with actuarial value of approximately 87%
At 200–250% FPL, a Silver CSR plan has an enhanced actuarial value of approximately 87%.
Which of the following is a qualifying life event that would open a Special Enrollment Period for an individual who currently has no health coverage?
Answer: Gaining a dependent through adoption
Gaining a dependent through adoption, birth, or placement in foster care is a qualifying life event that triggers a SEP.
A consumer is determined eligible for Medicaid by the Marketplace and sent to their state Medicaid agency. The state agency later denies eligibility. What option does the consumer have for Marketplace coverage?
Answer: They receive a SEP to enroll in a Marketplace plan
A denial of Medicaid or CHIP eligibility triggers a Special Enrollment Period allowing the consumer to enroll in a Marketplace plan.
For Marketplace APTC purposes, which of the following individuals would be included in the applicant's 'tax household' even if they do not need coverage?
Answer: A spouse filing a joint return
A spouse who files a joint federal tax return is included in the applicant's tax household regardless of whether they need coverage.
An enrollment counselor discovers that an applicant received APTC but did not file a tax return to reconcile it. What consequence may the applicant face in subsequent years?
Answer: They may be barred from receiving APTC in future years until they file and reconcile
Failure to file and reconcile APTC can result in a consumer being ineligible to receive advance payments of the premium tax credit in future coverage years.