ACA & Marketplace Fundamentals Flashcards

A 35-year-old applicant earns 150% of FPL and qualifies for Medicaid in an expansion state. What should an enrollment counselor advise?

Answer: Apply for Medicaid immediately

Individuals who qualify for Medicaid should apply for Medicaid, as they cannot receive premium tax credits if they are eligible for Medicaid.

What is the annual Open Enrollment Period (OEP) for individual Marketplace coverage for the 2024 plan year?

Answer: November 1 – January 15, 2024

The 2024 OEP ran from November 1, 2023 through January 15, 2024, with coverage starting January 1 for enrollments completed by December 15.

Which of the following qualifying life events triggers a Special Enrollment Period?

Answer: Moving to a new county with different plan options

Moving to a new service area with different Marketplace plan options is a qualifying life event that triggers a 60-day Special Enrollment Period.

The Advance Premium Tax Credit (APTC) is paid directly to whom?

Answer: The health insurance company on the enrollee's behalf

APTC is paid directly to the insurance company, reducing the enrollee's monthly premium amount owed.

A Catastrophic health plan on the Marketplace is available only to individuals who are:

Answer: Under age 30 or have a hardship/affordability exemption

Catastrophic plans are limited to individuals under 30 or those who qualify for a hardship or affordability exemption.

What happens if an enrollee's income is higher than estimated at the end of the tax year and they received too much APTC?

Answer: They must repay some or all of the excess APTC when filing taxes

Excess APTC must be reconciled on the enrollee's federal tax return, and they may owe repayment of some or all of the overpaid credit.

Which of the following is considered Minimum Essential Coverage (MEC) under the ACA?

Answer: Employer-sponsored group health plans

Employer-sponsored group health plans that meet ACA standards qualify as Minimum Essential Coverage.