CACs Verification and Documentation Requirements 3

Question 1

What is the consequence for an APTC recipient who fails to resolve a data matching issue within the allotted timeframe?

Accepted Answer

Their advance premium tax credit and cost-sharing reductions may be terminated

Answer

They receive a retroactive increase in tax credits

Answer

Their case is automatically forwarded to state Medicaid for review

Answer

They are permanently barred from reapplying to the Marketplace

Question 2

Which document best verifies that an applicant had prior qualifying health coverage, which may be needed for certain SEP eligibility determinations?

Accepted Answer

A COBRA election notice or letter of creditable coverage from a prior insurer

Answer

A doctor's office visit receipt

Answer

An applicant's personal written statement of prior coverage

Answer

A pharmacy prescription printout

Question 3

When calculating Modified Adjusted Gross Income (MAGI) household income for Marketplace eligibility, which type of income MUST be included?

Accepted Answer

Tax-exempt Social Security benefits received by the tax filer

Answer

Gifts received from family members

Answer

Child support payments received

Answer

Workers' compensation settlements

Question 4

If an applicant's Social Security number cannot be verified electronically through the Federal Data Services Hub, what is the recommended next step?

Accepted Answer

Request that the applicant submit paper documentation such as their Social Security card or SSA correspondence

Answer

Deny the application immediately and advise the applicant to reapply next open enrollment

Answer

Contact the IRS directly on the applicant's behalf to resolve the discrepancy

Answer

Advise the applicant to apply for a new SSN from the SSA

Question 5

For consumers receiving Advance Premium Tax Credits (APTC), what annual process requires income re-verification and may result in adjusted financial assistance?

Accepted Answer

Annual redetermination and renewal during open enrollment

Answer

Monthly eligibility redetermination

Answer

Quarterly income reporting to the IRS

Answer

Weekly confirmation of enrollment status with the issuer

Question 6

What does 'reasonable compatibility' mean in the context of Marketplace income verification?

Accepted Answer

The applicant's attested income is within an acceptable percentage range of what IRS records show, so no further documentation is required

Answer

The applicant's income is identical to what the IRS reported to the cent

Answer

The Marketplace accepts any income the applicant states without cross-referencing IRS data

Answer

The applicant's income qualifies them for both Medicaid and Marketplace subsidies simultaneously

Question 7

Which of the following is an acceptable document to verify a loss-of-coverage qualifying life event for a Special Enrollment Period?

Accepted Answer

A termination of coverage letter or COBRA election notice from the prior health plan

Answer

A personal email from the applicant stating they lost coverage

Answer

A receipt from a doctor's office showing unpaid medical bills

Answer

A signed affidavit from the applicant's employer