CEC - Certified Enrollment Counselor ACA & Marketplace Fundamentals Questions and Answers — Questions and Answers
Question 1: A consumer loses their employer-sponsored health coverage on June 15th. Under ACA rules, what is the latest date they can typically enroll in a new Marketplace plan through a Special Enrollment Period (SEP)?
- June 30th
- July 15th
- August 14th (Correct answer)
- December 15th
Correct answer: August 14th
Losing qualifying health coverage is a life event that triggers a Special Enrollment Period. Generally, individuals have 60 days from the date of losing coverage to select a new Marketplace plan. Therefore, 60 days from June 15th is August 14th.
Question 2: Which of the following is a primary responsibility of a Certified Enrollment Counselor (CEC)?
- Recommending a specific Qualified Health Plan (QHP) to the consumer.
- Providing fair, accurate, and impartial information about health coverage options. (Correct answer)
- Determining the consumer's final eligibility for Medicaid.
- Paying the consumer's first month's premium to ensure enrollment.
Correct answer: Providing fair, accurate, and impartial information about health coverage options.
Certified Enrollment Counselors must provide information and services in a fair, accurate, and impartial manner. Their role is to help consumers understand their options and facilitate enrollment, but they are explicitly prohibited from recommending specific plans, which is the role of a licensed agent or broker.
Question 3: A family of three has a Modified Adjusted Gross Income (MAGI) that is 225% of the Federal Poverty Level (FPL). To receive the maximum available financial assistance for out-of-pocket costs, which type of Marketplace plan must they enroll in?
- Bronze
- Silver (Correct answer)
- Gold
- Platinum
Correct answer: Silver
Cost-Sharing Reductions (CSRs), which lower out-of-pocket costs like deductibles and copayments, are only available to eligible individuals and families who enroll in a Silver plan. Eligibility for CSRs is based on income, typically between 100% and 250% of the FPL.
Question 4: To be eligible to enroll in health coverage through the Health Insurance Marketplace, an individual must meet several requirements. Which of the following is NOT a standard eligibility requirement?
- Be a U.S. citizen or lawfully present immigrant.
- Live in the service area of the Marketplace.
- Be employed at least part-time. (Correct answer)
- Not be incarcerated.
Correct answer: Be employed at least part-time.
Marketplace eligibility is not dependent on employment status. An individual must live in the United States, be a U.S. citizen or be lawfully present, and not be incarcerated. Unemployed individuals can still be eligible for and enroll in Marketplace coverage.
Question 5: A 28-year-old consumer is looking for a health plan with the lowest possible monthly premium, and they do not expect to need frequent medical services. Which metal level plan would most likely meet their primary objective?
- Platinum
- Gold
- Silver
- Bronze (Correct answer)
Correct answer: Bronze
Bronze plans are characterized by having the lowest monthly premiums. In exchange, they have the highest out-of-pocket costs (like deductibles and copayments) when care is needed. This structure is often suitable for younger, healthier individuals who want protection from major medical events but want to keep fixed monthly costs low.
Question 6: A consumer is assisting their 66-year-old parent who is enrolled in Medicare Part A and Part B. The parent wants to also enroll in a Marketplace plan for additional benefits. How should the Certified Enrollment Counselor advise them?
- They can enroll in a Marketplace plan and disenroll from Medicare.
- They can enroll in a Marketplace dental plan, but not a health plan.
- It is illegal for someone to sell a Marketplace policy to a person with Medicare coverage. (Correct answer)
- They should enroll in a Bronze plan to supplement their Medicare.
Correct answer: It is illegal for someone to sell a Marketplace policy to a person with Medicare coverage.
An individual enrolled in Medicare is not eligible to purchase a Health Insurance Marketplace plan. It is against the law for someone to knowingly sell a Marketplace plan to a person who has Medicare. If someone has a Marketplace plan and then becomes eligible for Medicare, they can keep the Marketplace plan but will lose any premium tax credits.
CEC - Certified Enrollment Counselor ACA & Marketplace Fundamentals Questions and Answers
A consumer loses their employer-sponsored health coverage on June 15th.
Under ACA rules, what is the latest date they can typically enroll in a new Marketplace plan through a Special Enrollment Period (SEP)?