CACs Consumer Education and Assistance 2 — Questions and Answers
Question 1: A consumer asks a CAC about the difference between a premium tax credit and a cost-sharing reduction. Which statement best describes cost-sharing reductions (CSRs)?
- CSRs reduce the monthly premium a consumer pays for their plan
- CSRs lower out-of-pocket costs like deductibles, copays, and coinsurance (Correct answer)
- CSRs are available on any metal-tier plan purchased through the Marketplace
- CSRs are automatically applied to all Marketplace plans regardless of income
Correct answer: CSRs lower out-of-pocket costs like deductibles, copays, and coinsurance
Cost-sharing reductions lower out-of-pocket costs such as deductibles, copayments, and coinsurance, and are only available on Silver plans for eligible consumers.
Question 2: A consumer who is newly employed wants to enroll in Marketplace coverage outside of Open Enrollment. Which qualifying life event would make them eligible for a Special Enrollment Period?
- Starting a new job that does not offer employer-sponsored insurance (Correct answer)
- Voluntarily canceling a previous health plan
- Moving to a new apartment within the same ZIP code
- Increasing their income above 400% FPL
Correct answer: Starting a new job that does not offer employer-sponsored insurance
Losing or gaining access to job-based coverage is a qualifying life event that triggers a Special Enrollment Period.
Question 3: When educating a consumer about the Marketplace's metal tiers, a CAC should explain that actuarial value (AV) represents:
- The quality rating assigned to a health insurance plan by CMS
- The percentage of covered medical costs the plan pays on average for the standard population (Correct answer)
- The maximum amount a consumer pays out-of-pocket in a plan year
- The monthly premium before any tax credits are applied
Correct answer: The percentage of covered medical costs the plan pays on average for the standard population
Actuarial value is the average percentage of covered health care costs the plan pays for a standard population, with higher AV meaning lower average out-of-pocket costs.
Question 4: A consumer reports they received a notice that their income-based Medicaid was terminated due to a change in state policy. As a CAC, your first recommended action is to:
- Immediately enroll them in a Marketplace Silver plan with a premium tax credit
- Advise them to appeal the termination through the Medicaid agency before seeking alternatives (Correct answer)
- Explain that Medicaid termination does not qualify as a life event for a SEP
- Refer them to a private broker for COBRA continuation coverage
Correct answer: Advise them to appeal the termination through the Medicaid agency before seeking alternatives
Consumers should first be advised to appeal a Medicaid termination through the state Medicaid agency, as reinstatement may be possible before pursuing other options.
Question 5: Which of the following best describes the role of a CAC when helping a consumer compare health plans?
- Recommending the plan the CAC's organization has a financial interest in promoting
- Selecting the plan on the consumer's behalf based on their demographics
- Presenting objective information about plan options so the consumer can make an informed choice (Correct answer)
- Limiting the discussion to plans that are within the consumer's current budget
Correct answer: Presenting objective information about plan options so the consumer can make an informed choice
CACs must present objective, unbiased information about all available plan options and let the consumer make the final decision.
Question 6: A consumer asks if their undocumented family members can enroll in Marketplace coverage. A CAC should explain that:
- Undocumented individuals are eligible for premium tax credits but not full Marketplace plans
- Undocumented individuals are not eligible to enroll in Marketplace or Medicaid coverage (Correct answer)
- Undocumented children may enroll in CHIP regardless of state
- Undocumented individuals may enroll during a Special Enrollment Period only
Correct answer: Undocumented individuals are not eligible to enroll in Marketplace or Medicaid coverage
Undocumented individuals are not eligible to enroll in Marketplace plans or Medicaid, though some states provide limited emergency coverage.
Question 7: A consumer is confused about the Notice of Premium Tax Credit Eligibility they received after submitting a Marketplace application. As a CAC, you should explain this notice means:
- Their application has been denied and they must reapply with additional documents
- They have been automatically enrolled in a Marketplace plan
- They qualify for financial assistance and can shop for plans with that credit applied (Correct answer)
- They must pay full premiums first and will be reimbursed at tax time only
Correct answer: They qualify for financial assistance and can shop for plans with that credit applied
An eligibility notice confirming premium tax credit eligibility means the consumer can shop for Marketplace plans and apply the credit to reduce monthly premiums.
CACs Consumer Education and Assistance 2
A consumer asks a CAC about the difference between a premium tax credit and a cost-sharing reduction.
Which statement best describes cost-sharing reductions (CSRs)?