CACs Eligibility and Enrollment 5

Question 1

A consumer receiving unemployment compensation in 2021 or later signs up for Marketplace coverage. What special provision applies?

Accepted Answer

They may qualify for a full premium subsidy (benchmark plan at $0) under unemployment SEP rules

Answer

They are automatically enrolled in Medicaid

Answer

They must prove they are actively seeking work

Answer

They are exempt from all premiums for 12 months

Question 2

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

Accepted Answer

Not eligible for Marketplace enrollment

Answer

Fully eligible for Marketplace and APTC

Answer

Eligible for Marketplace but not APTC

Answer

Automatically enrolled in Medicaid

Question 3

Which of the following is NOT considered a qualifying health plan (QHP) for ACA purposes?

Accepted Answer

Short-term limited duration health insurance

Answer

A Silver HMO plan sold on the Marketplace

Answer

A stand-alone dental plan sold on the Marketplace

Answer

A Bronze PPO plan sold on the Marketplace

Question 4

A consumer turns 26 and is dropped from a parent's health plan on their birthday. How long do they have to enroll in their own Marketplace plan?

Accepted Answer

60 days

Answer

30 days

Answer

90 days

Answer

Until the next Open Enrollment Period only

Question 5

The annual Open Enrollment Period for Marketplace coverage in most states typically runs from:

Accepted Answer

November 1 – January 15 (or January 31 in some states)

Answer

September 1 – November 30

Answer

October 1 – December 31

Answer

December 1 – February 28

Question 6

A CAC is helping a consumer whose income fluctuates between 90% and 160% FPL from year to year. What key advice should the CAC provide?

Accepted Answer

Estimate income carefully and report changes promptly to ensure correct program placement and avoid subsidy reconciliation issues

Answer

Always report 160% FPL to avoid any Medicaid enrollment

Answer

Enroll in Medicaid regardless of income for maximum benefits

Answer

CACs cannot assist consumers with fluctuating income

Question 7

An employer offers coverage to a worker but not to the worker's spouse. The spouse's income is 200% FPL. What is the spouse's eligibility for Marketplace subsidies?

Accepted Answer

Eligible for APTC because the offer does not extend to the spouse

Answer

Ineligible because the household has access to ESI

Answer

Only eligible if the worker declines the ESI offer

Answer

Eligible only for Medicaid based on her individual income