CACs - Certified Application Counselor Eligibility and Enrollment Process Questions and Answers 1 — Questions and Answers
Question 1: A consumer loses their job-based health coverage. How long do they generally have from the date of losing coverage to enroll in a new Marketplace plan through a Special Enrollment Period (SEP)?
- 30 days
- 60 days (Correct answer)
- 90 days
- Until the next Open Enrollment Period
Correct answer: 60 days
Most Special Enrollment Periods, including the one for loss of other health coverage, provide a 60-day window after the qualifying life event to enroll in a new plan.
Question 2: Which of the following is a primary eligibility requirement for an individual to purchase a health plan through the Health Insurance Marketplace?
- Must be employed full-time
- Must not be eligible for Medicare (Correct answer)
- Must have a pre-existing condition
- Must be a high-income earner
Correct answer: Must not be eligible for Medicare
To be eligible to enroll in health coverage through the Marketplace, an individual cannot be currently enrolled in Medicare. Other requirements include living in the United States, being a U.S. citizen or lawfully present, and not being incarcerated.
Question 3: A family is applying for Marketplace coverage. Which of the following documents would generally NOT be required during the application process?
- Social Security numbers for all applicants
- Employer and income information (e.g., pay stubs, W-2s)
- A high school diploma or GED certificate (Correct answer)
- Document information for lawfully present immigrants
Correct answer: A high school diploma or GED certificate
The Marketplace application requires information to verify identity, citizenship/immigration status, and income. This includes Social Security numbers, pay stubs, and immigration documents. Educational attainment records like a high school diploma are not required.
Question 4: A Certified Application Counselor (CAC) is assisting a lawfully present immigrant who is a Lawful Permanent Resident (LPR, or 'Green Card' holder) and obtained this status two years ago. The consumer's income is low enough for Medicaid. Why might they be ineligible for Medicaid at this time?
- LPRs are never eligible for Medicaid.
- They must wait until they become a U.S. citizen.
- Many 'qualified non-citizens' are subject to a 5-year waiting period for Medicaid. (Correct answer)
- They can only apply for Marketplace coverage, not Medicaid.
Correct answer: Many 'qualified non-citizens' are subject to a 5-year waiting period for Medicaid.
Many lawfully present immigrants, including Lawful Permanent Residents, must have a 'qualified' immigration status for five years before they can become eligible for Medicaid, a rule often called the 'five-year bar'. There are exceptions for certain statuses like refugees and asylees.
Question 5: Which of the following scenarios would most likely trigger a Special Enrollment Period (SEP) for a consumer to enroll in a Marketplace plan outside of the annual Open Enrollment Period?
- Voluntarily cancelling their existing health plan.
- Choosing to not pay their monthly premium.
- Moving to a new zip code where different health plans are available. (Correct answer)
- Deciding they want a plan with a lower deductible.
Correct answer: Moving to a new zip code where different health plans are available.
Moving to a new area with different plan options is considered a qualifying life event that triggers a Special Enrollment Period. Voluntarily dropping coverage, failing to pay premiums, or simply wanting a different plan do not qualify an individual for an SEP.
Question 6: When a Certified Application Counselor (CAC) helps a consumer fill out a Marketplace application, what information must be collected for every member of the household, even those not applying for coverage?
- Medical history
- Income information (Correct answer)
- Educational background
- Driver's license numbers
Correct answer: Income information
The Marketplace application requires income information for all household members, even those not seeking coverage, because household income is a key factor in determining eligibility for premium tax credits and cost-sharing reductions.
CACs - Certified Application Counselor Eligibility and Enrollment Process Questions and Answers 1
A consumer loses their job-based health coverage.
How long do they generally have from the date of losing coverage to enroll in a new Marketplace plan through a Special Enrollment Period (SEP)?