CACs Eligibility and Enrollment 3

Question 1

What is the income range for eligibility to receive Advance Premium Tax Credits (APTC) in most states?

Accepted Answer

100%–400% FPL

Answer

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?

Accepted Answer

They are still eligible for APTC because the offer is unaffordable

Answer

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?

Accepted Answer

Getting married

Answer

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?

Accepted Answer

At least 200% FPL, with many states higher

Answer

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?

Accepted Answer

She must have a Special Enrollment Period qualifying event

Answer

Outside of Open Enrollment, plan changes are only permitted when a consumer has a qualifying SEP life event.

(CACs) Certified Application Counselor Practice Test

(CACs) Certified Application Counselor Practice Test

CACs Eligibility and Enrollment 3