Certified Application Counselor (CAC) Certification Exam — Questions and Answers

Question 1: A consumer's immigration status is 'Deferred Action for Childhood Arrivals' (DACA). What is their Marketplace eligibility?

Fully eligible for Marketplace and APTC
Automatically enrolled in Medicaid
Not eligible for Marketplace enrollment (Correct answer)
Eligible for Marketplace but not APTC

Correct answer: Not eligible for Marketplace enrollment

DACA recipients are not considered 'lawfully present' under federal ACA rules and are therefore not eligible to enroll in Marketplace plans (though some states have separate programs).

Question 2: A client insists on enrolling in a plan the CAC believes is a poor fit for their stated medical needs. After fully explaining the concerns, what should the CAC do?

Refuse to complete the enrollment since it is not in the client's best interest
Enroll the client in a different plan and explain the change afterward
Contact the insurer to flag the enrollment as potentially unsuitable
Complete the enrollment per the client's informed decision and document the discussion (Correct answer)

Correct answer: Complete the enrollment per the client's informed decision and document the discussion

Once a client is fully informed, their autonomous choice must be respected and completed even if the CAC disagrees with it.

Question 3: When using a consumer's phone number to send appointment reminders, a CAC should ensure:

The message includes the consumer's full name for clarity
The reminder is generic and does not reveal that the purpose involves health coverage enrollment (Correct answer)
The consumer's insurer receives a copy for care coordination
Reminders are only sent via landline to avoid data security issues

Correct answer: The reminder is generic and does not reveal that the purpose involves health coverage enrollment

Appointment reminders sent to phones should not disclose sensitive information such as the health coverage enrollment purpose in case the message is seen by others.

Question 4: When a CAC leaves an enrollment session at a shared workstation, what is the required action to protect consumer data?

Minimize the browser window showing consumer information
Log out of all Marketplace systems and lock or secure the workstation (Correct answer)
Ask a nearby colleague to monitor the screen
Leave the session open if returning within 30 minutes

Correct answer: Log out of all Marketplace systems and lock or secure the workstation

Logging out and locking the workstation prevents unauthorized access to open sessions containing consumer PII whenever the CAC steps away.

Question 5: Which of the following actions represents a violation of the 'principle of least privilege' regarding access to consumer PII?

Allowing all CACs at an organization to use a single, shared username and password for the system to make helping consumers faster. (Correct answer)
Accessing only the financial section of an application to help a consumer with income questions.
Using a unique, complex password to log into the Marketplace portal.
Securing paper applications in a locked file cabinet at the end of the day.

Correct answer: Allowing all CACs at an organization to use a single, shared username and password for the system to make helping consumers faster.

The principle of least privilege dictates that a user should only have the minimum access necessary to perform their job functions. Sharing a single login credential violates this by giving multiple users broad, unaudited access and makes it impossible to trace actions back to a specific individual. Individual accounts ensure accountability and limit potential damage if credentials are compromised.

Question 6: A CAC receives a subpoena requesting consumer enrollment records. The CAC should:

Forward the subpoena to HHS and await instructions
Inform the consumer and refuse to comply
Consult with their organization's legal counsel before releasing any information (Correct answer)
Comply immediately to avoid legal penalties

Correct answer: Consult with their organization's legal counsel before releasing any information

A subpoena may or may not require disclosure depending on its scope and applicable law; the CAC must consult legal counsel before releasing any consumer records.

Question 7: Which document is essential to provide to consumers when assisting with coverage options?

The IRS tax filing guide.
The Summary of Benefits and Coverage (SBC) (Correct answer)
A glossary of insurance terms only.
The provider’s internal policies.

Correct answer: The Summary of Benefits and Coverage (SBC)

The Summary of Benefits and Coverage (SBC) is a standardized document required by the Affordable Care Act (ACA) that provides a clear, concise summary of a health plan's benefits and coverage. It helps consumers compare different plans side-by-side by outlining costs, covered services, and limitations in an easy-to-understand format. Providing the SBC ensures transparency and empowers consumers to make informed decisions about their health insurance options.

Question 8: A consumer's employer offers health coverage, but the employee-only premium costs more than 9.02% of household income (2023 threshold). What does this mean for Marketplace eligibility?

The consumer must enroll in the employer plan first
The consumer qualifies for Medicaid instead
The consumer is ineligible for any Marketplace subsidies
The coverage is considered unaffordable and the consumer may qualify for Marketplace APTC (Correct answer)

Correct answer: The coverage is considered unaffordable and the consumer may qualify for Marketplace APTC

If employer coverage is unaffordable (employee-only premium exceeds the affordability threshold), the consumer may qualify for Marketplace subsidies.

Question 9: A CAC works for a hospital that is a CDO. The hospital's marketing department asks the CAC for a list of consumers who were successfully enrolled in Marketplace plans to send them a welcome packet and information about hospital services. Ethically, what must the CAC do?

Refuse the request, explaining that PII collected for enrollment purposes cannot be used for marketing without explicit, written consumer consent for that specific purpose. (Correct answer)
Provide the list but only for consumers who selected a plan affiliated with the hospital.
Provide the list, as the marketing materials are beneficial to the consumers.
Ask the consumers for verbal permission before adding them to the marketing list.

Correct answer: Refuse the request, explaining that PII collected for enrollment purposes cannot be used for marketing without explicit, written consumer consent for that specific purpose.

Personally Identifiable Information (PII) collected to assist with a Marketplace application is protected and can only be used for that purpose. Using this information for a secondary purpose, such as marketing, is a violation of the CAC's privacy and confidentiality obligations unless the consumer has provided explicit, written consent for that secondary use.

Question 10: For APTC purposes, what is considered 'affordable' employer-sponsored insurance under the ACA?

The employer pays at least 75% of the premium
Premiums cost less than 10% of gross income
Employee-only premium does not exceed a set percentage of household income (9.02% for 2024) (Correct answer)
The plan covers at least 50% of costs

Correct answer: Employee-only premium does not exceed a set percentage of household income (9.02% for 2024)

Employer coverage is considered affordable if the employee-only premium does not exceed the IRS affordability threshold (9.02% in 2024) of household income.

Question 11: What does 'creditable coverage' mean in the context of the ACA and Special Enrollment Periods?

Coverage that includes dental and vision
Coverage that is free of charge
Prior health insurance that counts toward satisfying waiting periods (Correct answer)
A plan with a credit score requirement

Correct answer: Prior health insurance that counts toward satisfying waiting periods

Creditable coverage refers to prior qualifying health coverage that may be used to satisfy enrollment requirements and avoid gaps triggering penalties.

Question 12: A client's primary language is Somali and no interpreter is immediately available. What is the best immediate action?

Reschedule the appointment and arrange a qualified Somali interpreter for the next session (Correct answer)
Proceed with the enrollment using gestures and pictures
Send the client written materials in English and ask them to return when they understand them
Ask a random bilingual staff member from another department to interpret

Correct answer: Reschedule the appointment and arrange a qualified Somali interpreter for the next session

When a qualified interpreter is not available, rescheduling to ensure proper language access is better than proceeding without effective communication.

Question 13: What must ALL Marketplace plans cover regardless of metal tier?

Elective cosmetic procedures
The 10 Essential Health Benefits (EHBs) (Correct answer)
Dental and vision benefits
Long-term care services

Correct answer: The 10 Essential Health Benefits (EHBs)

All Marketplace qualified health plans must cover the 10 Essential Health Benefits as required by the ACA.

Question 14: 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 have a pre-existing medical condition.
They must be eligible for Medicare Part A.
They must not be incarcerated. (Correct answer)
They must be employed full-time.

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 15: A client is confused and asks the CAC to just pick the best plan for them. What should the CAC do?

Select a plan based on personal judgment without further discussion
Pick the cheapest plan as a safe default
Explain that CACs cannot make the selection for clients but can guide comparison of options (Correct answer)
Refuse to continue the session until the client engages

Correct answer: Explain that CACs cannot make the selection for clients but can guide comparison of options

CACs facilitate informed decision-making but cannot make enrollment decisions on behalf of clients, as this would undermine client autonomy.

Question 16: A consumer is very happy with the assistance they received and insists on giving the CAC a $25 restaurant gift card as a thank you. According to the standards of conduct for assisters, what is the appropriate action?

Accept the gift on behalf of the CDO and turn it over to a supervisor.
Suggest the consumer mail the gift card to the CDO's main office instead.
Accept the gift, since its value is small and does not create a significant conflict of interest.
Politely decline the gift, explaining that assisters are prohibited from accepting payments or gifts of any amount from consumers. (Correct answer)

Correct answer: Politely decline the gift, explaining that assisters are prohibited from accepting payments or gifts of any amount from consumers.

Federal standards of conduct prohibit CACs from soliciting or accepting any gifts, payments, or other consideration from consumers for their assistance. This is a strict rule to prevent conflicts of interest and the appearance of impropriety. The only correct action is to politely decline the gift, regardless of its value.

Question 17: What is the significance of a CAC keeping their training certificates and documentation organized?

It is optional but helps improve client relationships
It is solely for the CAC's personal professional development records
It is required only if the CAC works in a federally-facilitated Marketplace state
It demonstrates compliance and supports oversight by CMS and the sponsoring organization (Correct answer)

Correct answer: It demonstrates compliance and supports oversight by CMS and the sponsoring organization

Maintaining organized training records demonstrates compliance and is necessary for audits and oversight by CMS and sponsoring organizations.

Question 18: Under the ACA, which of the following is NOT considered a minimum essential coverage (MEC) type?

Medicaid
A short-term limited-duration health plan (Correct answer)
CHIP
Medicare Part A

Correct answer: A short-term limited-duration health plan

Short-term limited-duration plans are explicitly excluded from the definition of minimum essential coverage under the ACA.

Question 19: A family of four with an income of 200% FPL applies for coverage. Which program should they FIRST be screened for?

Medicaid and CHIP before Marketplace plans (Correct answer)
Only Marketplace plans with APTC
Short-term health plans
Medicare

Correct answer: Medicaid and CHIP before Marketplace plans

CACs must screen all applicants for Medicaid and CHIP eligibility first, as these programs may provide more comprehensive and cost-effective coverage.

Question 20: A CAC discovers that a client provided incorrect income information on their Marketplace application. What is the CAC's primary obligation?

Advise the client to correct the information and submit an application update (Correct answer)
Report the client to the IRS immediately
Enroll the client anyway and note the discrepancy internally
Ignore it since the application is already submitted

Correct answer: Advise the client to correct the information and submit an application update

CACs must advise clients to provide accurate information and help them correct any errors on their applications.

Question 21: 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 lower the monthly health insurance premium for eligible individuals and families. (Correct answer)
To reimburse individuals for medical services already received.
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 22: According to federal standards for protecting consumer Personally Identifiable Information (PII), which of the following is an approved method for destroying paper documents containing sensitive PII?

Blacking out the consumer's name and address with a marker before discarding.
Tearing the documents into several pieces before placing them in a trash can.
Placing the documents in a standard, unlocked office recycling bin.
Using a cross-cut shredder to render the information unreconstructible. (Correct answer)

Correct answer: Using a cross-cut shredder to render the information unreconstructible.

Federal standards, such as those from NIST, require that PII be rendered unreadable, indecipherable, and unreconstructible. Cross-cut shredding, pulverizing, or incinerating are methods that meet this standard. The other methods are insufficient as they could allow a determined individual to reconstruct the sensitive information.

Question 23: When can consumers enroll in a health insurance plan outside of the open enrollment period?

When they qualify for a Special Enrollment Period (Correct answer)
Only with approval from a health provider.
Only during tax season.
Once every three years.

Correct answer: When they qualify for a Special Enrollment Period

Outside of the annual Open Enrollment Period, consumers can only enroll in or change health insurance plans if they experience a qualifying life event. These events, such as marriage, birth of a child, loss of other coverage, or moving, trigger a Special Enrollment Period (SEP). SEPs ensure that individuals can access coverage when significant life changes impact their health insurance needs.

Question 24: Which program offers coverage to children in families that earn too much for Medicaid but cannot afford private insurance?

Medicare
TRICARE
CHIP (Correct answer)
Marketplace Platinum plan

Correct answer: CHIP

CHIP (Children's Health Insurance Program) fills the coverage gap for children in families whose income exceeds Medicaid limits but is still low enough to qualify for subsidized coverage.

Question 25: What is the primary purpose of a CAC providing a consumer with a privacy notice?

To inform the consumer about how their information will be collected, used, and protected (Correct answer)
To replace the Marketplace's own privacy disclosure requirements
To satisfy a legal requirement that automatically authorizes data sharing
To obtain consent to sell their data to third-party marketers

Correct answer: To inform the consumer about how their information will be collected, used, and protected

Privacy notices inform consumers of their rights and explain how the CAC organization collects, uses, and safeguards their personal information.

Certified Application Counselor (CAC) Certification Exam

The CMS Certified Application Counselor (CAC) exam certifies individuals to help consumers apply for and enroll in health coverage through the ACA Marketplace. It covers ACA law, marketplace plan options, eligibility, privacy and security standards, ethics, and serving diverse populations.

Questions

35 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds