ACA & Marketplace Fundamentals Flashcards
7 cards from real CEC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 ACA & Marketplace Fundamentals flashcards as text
Under the ACA's guaranteed issue requirement, insurers in the individual Marketplace must:
Answer: Accept all applicants regardless of health status during open or special enrollment periods
Guaranteed issue prohibits Marketplace insurers from denying coverage or charging more based on health status during enrollment periods.
What is the role of the risk corridor program established under the ACA?
Answer: To limit insurer losses or gains during the first years of Marketplace operation
Risk corridors were a temporary program designed to stabilize insurer profits/losses in the first three years of ACA Marketplace operation (2014-2016).
A consumer enrolling on November 20 during Open Enrollment selects a plan. When does their coverage begin if no earlier start date applies?
Answer: January 1 of the following year
Enrollments completed between December 16 and January 15 have a February 1 effective date, but a November 20 enrollment results in a January 1 effective date.
Which of the following is a permissible rating factor that insurers may use to vary premiums in ACA Marketplace plans?
Answer: Age (within a 3:1 ratio limit)
The ACA allows insurers to vary premiums based on age (up to 3:1 ratio), tobacco use, family size, and geographic area, but prohibits gender and health status rating.
What income threshold (as a percentage of FPL) must an individual be at or above to be eligible for Marketplace premium tax credits rather than Medicaid?
Answer: 100% FPL in non-expansion states; 138% FPL in expansion states
In Medicaid expansion states, APTC eligibility starts at 138% FPL; in non-expansion states, it starts at 100% FPL because those below 138% have no Medicaid option.
A Certified Application Counselor (CAC) differs from a Navigator primarily in that CACs:
Answer: Are designated and trained by certified application counselor organizations such as hospitals and health centers
CACs are designated by CMS-approved organizations (like FQHCs or hospitals) and trained to help consumers enroll, but they cannot charge fees or accept insurer compensation.
Under the ACA's individual mandate (before the penalty was reduced to $0 in 2019), what was the primary enforcement mechanism?
Answer: A shared responsibility payment collected through the federal tax return
The individual mandate was enforced via a 'shared responsibility payment' (tax penalty) assessed on the federal income tax return for those without MEC.