CEC - Certified Enrollment Counselor Post-Enrollment and Renewals Questions and Answers

Question 1

A consumer who is enrolled in a Marketplace plan with APTC experiences a significant, permanent increase in household income mid-year. What is their primary responsibility regarding this change?

Accepted Answer

Report the change to the Marketplace within 30 days.

Answer

Wait until the next Open Enrollment Period to update their information.

Answer

Notify their insurance company directly of the income change.

Answer

Wait to reconcile the difference when they file their federal income taxes.

Question 2

During the annual renewal period, a consumer who takes no action is automatically re-enrolled. However, their specific 2025 plan is being discontinued by the insurer. What is the most likely action the Marketplace will take?

Accepted Answer

Automatically enroll the consumer into a similar plan from the same insurer, or a different insurer if a similar plan is not available from the original one.

Answer

Terminate the consumer's coverage and financial assistance.

Answer

Automatically enroll the consumer into the lowest-cost Bronze plan available.

Answer

Send a notice that the consumer must select a new plan within 30 days or they will have a gap in coverage.

Question 3

A consumer who receives Advance Premium Tax Credits (APTC) has paid their premium for January, February, and March but fails to pay their April premium on time. Under the ACA, what is the required grace period an insurer must provide before terminating coverage?

Accepted Answer

90 days, during which the insurer must pay claims for the first month but may pend claims for the second and third months.

Answer

30 days, during which all claims must be paid.

Answer

60 days, with the insurer having the option to pend claims for the entire period.

Answer

A period ending on the last day of the month for which the premium was due.

Question 4

A consumer with existing Marketplace coverage wants to change their plan mid-year. Which of the following qualifying life events will most likely allow them to select a new plan from a different insurance company and potentially a different metal level?

Accepted Answer

A permanent move to a new ZIP code where their current plan is not offered.

Answer

A change in income that makes them newly eligible for cost-sharing reductions (CSRs).

Answer

The birth of a child, adding a new dependent to the household.

Answer

Getting married, which changes their household size and tax filing status.

Question 5

When assisting a consumer with their annual renewal during Open Enrollment, what is the most important best practice for a Certified Enrollment Counselor to follow?

Accepted Answer

Encourage the consumer to actively review and update their application and compare all available plan options.

Answer

Advise the consumer to allow passive (automatic) re-enrollment to ensure there is no gap in coverage.

Answer

Recommend the plan with the lowest premium, as that is the most common consumer priority.

Answer

Focus only on updating the income section, as it is the most critical for financial assistance.

Question 6

A consumer receives a Data Matching Issue (DMI) notice regarding their immigration status. The notice states they have 95 days to submit valid documentation. If the consumer fails to respond and resolve the issue within the specified timeframe, what is the most likely consequence?

Accepted Answer

Their eligibility for Marketplace coverage will be terminated, resulting in a loss of their health plan.

Answer

Their financial assistance will be removed, but they can keep the plan by paying the full premium.

Answer

They will be assessed a penalty during the next tax filing season.

Answer

Their enrollment will be automatically switched to a state Medicaid plan.

A consumer who is enrolled in a Marketplace plan with APTC experiences a significant, permanent increase in household income mid-year.What is their primary responsibility regarding this change?

A consumer who is enrolled in a Marketplace plan with APTC experiences a significant, permanent increase in household income mid-year.
What is their primary responsibility regarding this change?