CACs - Certified Application Counselor Affordable Care Act Basics Questions and Answers 1 — Questions and Answers
Question 1: A consumer loses their employer-sponsored health coverage. Under the Affordable Care Act, this event typically triggers a:
- Special Enrollment Period (SEP) (Correct answer)
- Marketplace waiting period
- Medicaid eligibility review
- Premium penalty assessment
Correct answer: Special Enrollment Period (SEP)
Losing job-based health insurance is considered a Qualifying Life Event (QLE), which makes an individual eligible for a Special Enrollment Period (SEP). This allows them to enroll in a new health plan through the Marketplace outside of the annual Open Enrollment Period.
Question 2: Which of the following is a key role of a Certified Application Counselor (CAC)?
- Recommending a specific insurance plan to a consumer.
- Helping consumers understand their eligibility for Marketplace plans, Medicaid, and CHIP. (Correct answer)
- Determining a consumer's final tax liability for the Premium Tax Credit.
- Selling insurance plans on behalf of private companies.
Correct answer: Helping consumers understand their eligibility for Marketplace plans, Medicaid, and CHIP.
The primary role of a CAC is to provide fair, impartial, and accurate information to help consumers understand their options and assist them with the application process for Marketplace coverage, Medicaid, and the Children's Health Insurance Program (CHIP). They are not permitted to sell insurance or recommend specific plans.
Question 3: Under the ACA, what is the primary purpose of the Advanced Premium Tax Credit (APTC)?
- To cover all out-of-pocket costs like deductibles and copayments.
- To reimburse individuals for medical services already received.
- To lower the monthly health insurance premium for eligible individuals and families. (Correct answer)
- To provide a tax deduction for those who purchase off-Marketplace plans.
Correct answer: To lower the monthly health insurance premium for eligible individuals and families.
The Advanced Premium Tax Credit (APTC) is a subsidy the federal government pays directly to the insurance company to lower the consumer's monthly premium for plans purchased through the Health Insurance Marketplace.
Question 4: A 28-year-old single adult with an annual income of 130% of the Federal Poverty Level (FPL) lives in a state that has expanded Medicaid. Which program are they most likely eligible for?
- A subsidized Marketplace plan only
- Medicare
- A catastrophic health plan
- Medicaid (Correct answer)
Correct answer: Medicaid
The ACA allows states to expand Medicaid to cover most low-income adults under age 65 with household incomes up to 138% of the FPL. In a state that has adopted expansion, this individual's income would make them eligible for Medicaid.
Question 5: Which of the following is a fundamental requirement for an individual to be eligible to enroll in a Qualified Health Plan through the Health Insurance Marketplace?
- They must be employed full-time.
- They must not be incarcerated. (Correct answer)
- They must have a pre-existing medical condition.
- They must be eligible for Medicare Part A.
Correct answer: They must not be incarcerated.
To be eligible to enroll in health coverage through the Marketplace, an individual must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated. Individuals enrolled in Medicare are not eligible to purchase a Marketplace plan.
Question 6: Under the Affordable Care Act, most health plans must cover certain preventive services at no cost to the consumer. This means:
- The services are free regardless of whether the provider is in-network or out-of-network.
- The consumer does not have to pay a copayment, coinsurance, or deductible for these services when received from an in-network provider. (Correct answer)
- All medical services, including emergency care, are covered without cost-sharing.
- Only high-deductible health plans are required to offer free preventive care.
Correct answer: The consumer does not have to pay a copayment, coinsurance, or deductible for these services when received from an in-network provider.
The ACA requires most private health plans to cover a list of preventive services without any cost-sharing (copay, coinsurance, or deductible) when these services are delivered by a provider in the plan's network.
CACs - Certified Application Counselor Affordable Care Act Basics Questions and Answers 1
A consumer loses their employer-sponsored health coverage.
Under the Affordable Care Act, this event typically triggers a: