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

Failure to resolve a data matching issue within the required period can result in termination of the applicant's APTC and cost-sharing reductions, and potentially their enrollment.

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 COBRA election notice or a letter of creditable coverage from a prior insurance carrier is the standard documentation used to verify prior health coverage.

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

Tax-exempt Social Security income must be added back into MAGI for Marketplace eligibility calculations, even though it is excluded from regular taxable income.

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

When electronic SSN verification fails, the applicant is asked to provide paper documentation such as their Social Security card or an official SSA-issued letter to resolve the inconsistency.

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

Each year during open enrollment, the Marketplace performs an annual redetermination using updated IRS income data to re-verify eligibility and adjust APTC amounts accordingly.

(CACs) Certified Application Counselor Practice Test

(CACs) Certified Application Counselor Practice Test

CACs Verification and Documentation Requirements 3