CACs Eligibility and Enrollment Process 3 — Questions and Answers
Question 1: For Marketplace eligibility, Modified Adjusted Gross Income (MAGI) is used to calculate household income. Which income type is included in MAGI?
- Child support received
- Gifts over $15,000
- Supplemental Security Income (SSI)
- Social Security benefits that are taxable (Correct answer)
Correct answer: Social Security benefits that are taxable
Taxable Social Security benefits are included in MAGI, while SSI, child support received, and gifts are excluded.
Question 2: A family of four has a projected annual income of 180% FPL. Which program are they most likely eligible for?
- Premium tax credits only
- Medicaid or CHIP depending on state expansion status (Correct answer)
- Cost-sharing reductions only
- Neither APTC nor Medicaid
Correct answer: Medicaid or CHIP depending on state expansion status
At 180% FPL, this family falls within Medicaid or CHIP eligibility thresholds in most states (Medicaid for adults in expansion states, CHIP for children).
Question 3: What is the upper income limit for premium tax credit (APTC) eligibility under the ACA through 2025?
- 300% FPL
- 400% FPL
- No upper income limit through 2025 under the enhanced subsidies (Correct answer)
- 500% FPL
Correct answer: No upper income limit through 2025 under the enhanced subsidies
Under the American Rescue Plan Act extensions, enhanced APTCs have no upper income cap through 2025, meaning even higher-income consumers may qualify.
Question 4: Which household members must be included when calculating household size for Marketplace eligibility?
- Only the tax filer and spouse
- The tax filer, spouse, and all tax dependents (Correct answer)
- All people living in the home regardless of tax filing status
- Only members applying for coverage
Correct answer: The tax filer, spouse, and all tax dependents
Marketplace household size is based on the tax household: the filer, spouse, and all claimed tax dependents.
Question 5: A 25-year-old is claimed as a tax dependent by her parents but wants to enroll in her own Marketplace plan. What happens to her eligibility?
- She enrolls independently using her own income only
- Her eligibility is based on her parents' household income (Correct answer)
- She is automatically eligible for Medicaid
- She cannot enroll in the Marketplace until she files independently
Correct answer: Her eligibility is based on her parents' household income
If someone is claimed as a tax dependent, their Marketplace eligibility is assessed based on the claiming household's income and size.
Question 6: Cost-sharing reductions (CSRs) are available to consumers who enroll in which plan metal tier?
- Bronze plans only
- Gold or Platinum plans
- Silver plans only (Correct answer)
- Any plan on the Marketplace
Correct answer: Silver plans only
CSRs are only available when consumers enroll in a Silver plan; they reduce deductibles, copays, and out-of-pocket maximums.
Question 7: A consumer estimates she will earn 95% FPL this year. She applies for Marketplace coverage. What should the CAC advise?
- Enroll in a Marketplace plan and claim the full APTC
- Apply for Medicaid since she is under 100% FPL (Correct answer)
- She is ineligible for any subsidized coverage
- Enroll in a Marketplace plan without APTC and pay full premium
Correct answer: Apply for Medicaid since she is under 100% FPL
In states that have expanded Medicaid, adults with income under 138% FPL are directed to Medicaid rather than Marketplace subsidies.
CACs Eligibility and Enrollment Process 3
For Marketplace eligibility, Modified Adjusted Gross Income (MAGI) is used to calculate household income.
Which income type is included in MAGI?