CACs Eligibility and Enrollment 3 — Questions and Answers
Question 1: What is the income range for eligibility to receive Advance Premium Tax Credits (APTC) in most states?
- 100%–300% FPL
- 100%–400% FPL (Correct answer)
- 138%–400% FPL
- 100%–500% FPL
Correct answer: 100%–400% FPL
APTCs are generally available to individuals and families with MAGI between 100% and 400% FPL (the ARP temporarily extended this, but the standard rule is 100–400%).
Question 2: A consumer is offered employer-sponsored insurance (ESI) that costs 12% of household income. How does this affect their Marketplace subsidy eligibility?
- They are still eligible for APTC because the offer is unaffordable (Correct answer)
- They are ineligible for APTC because the offer meets minimum value
- They can choose Marketplace but will lose all subsidies
- Employer coverage never affects Marketplace eligibility
Correct answer: They are still eligible for APTC because the offer is unaffordable
If the employee-only ESI premium exceeds the ACA's affordability threshold (roughly 9.02–9.12% of household income depending on the year), the offer is considered unaffordable and the consumer may qualify for APTC.
Question 3: Which of the following life events qualifies as a Special Enrollment Period trigger?
- Deciding you cannot afford your current plan
- Getting married (Correct answer)
- Your income increases significantly
- Your plan's premium rises
Correct answer: Getting married
Marriage is a qualifying life event that triggers a 60-day Special Enrollment Period to enroll in or change Marketplace coverage.
Question 4: CHIP provides coverage for children in families up to what income level in most states?
- 100% FPL
- 138% FPL
- 200% FPL
- At least 200% FPL, with many states higher (Correct answer)
Correct answer: At least 200% FPL, with many states higher
Federal law requires states to cover children in CHIP up to at least 200% FPL, and many states set their thresholds significantly higher.
Question 5: A consumer enrolled in a Silver plan wants to change to a Gold plan in February. What must be true for this change to be allowed?
- She must have a Special Enrollment Period qualifying event (Correct answer)
- She can change plans at any time during the plan year
- She must contact the insurance company directly
- She must disenroll first and re-enroll during Open Enrollment
Correct answer: She must have a Special Enrollment Period qualifying event
Outside of Open Enrollment, plan changes are only permitted when a consumer has a qualifying SEP life event.
Question 6: When a consumer reports income changes during the plan year, what should a CAC advise?
- Wait until year-end tax filing to reconcile
- Report changes promptly to avoid large tax repayment or missed savings (Correct answer)
- Only report changes if income drops by more than 20%
- Changes in income do not affect APTC during the plan year
Correct answer: Report changes promptly to avoid large tax repayment or missed savings
Reporting income changes promptly helps consumers receive accurate APTCs and avoids large reconciliation payments or foregone subsidies at tax time.
Question 7: Which population is automatically enrolled in Medicare Part A at age 65 without an application?
- Anyone who has lived in the U.S. for 10 years
- Those already receiving Social Security or Railroad Retirement Board benefits (Correct answer)
- All U.S. citizens regardless of work history
- Those with employer-sponsored insurance
Correct answer: Those already receiving Social Security or Railroad Retirement Board benefits
Individuals already collecting Social Security or RRB benefits are automatically enrolled in Medicare Part A and B when they turn 65.
CACs Eligibility and Enrollment 3
What is the income range for eligibility to receive Advance Premium Tax Credits (APTC) in most states?