Eligibility Determination Process 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 Eligibility Determination Process flashcards as text
A consumer is incarcerated but pending disposition of charges. Are they eligible to enroll in a Marketplace plan?
Answer: Yes, pending disposition of charges they are eligible to enroll
Individuals incarcerated pending disposition of charges are not excluded from Marketplace eligibility; only those incarcerated post-conviction are excluded.
What is the upper income limit (as a percentage of FPL) for eligibility to receive Advance Premium Tax Credits under the ACA for 2024?
Answer: No upper limit through 2025 under enhanced subsidies
The American Rescue Plan Act eliminated the 400% FPL cliff through 2025 (extended by the Inflation Reduction Act), so there is no hard upper income limit for APTC.
A Marketplace applicant's data-matching issue shows the SSA cannot verify their Social Security number. What is the standard timeline for the consumer to resolve this inconsistency?
Answer: 90 days
Consumers typically have 90 days to resolve data-matching inconsistencies by submitting documentation to the Marketplace.
Which of the following household sizes would place a family at exactly 100% of the 2024 Federal Poverty Level for the contiguous 48 states?
Answer: Single individual earning $15,060/year
For 2024, 100% FPL for a single individual in the contiguous 48 states is $15,060.
A consumer enrolled mid-year reports a change in income that drops them below 100% FPL. What happens to their APTC eligibility?
Answer: They may be transitioned to Medicaid if otherwise eligible
If a consumer's income drops below 100% FPL and they are Medicaid-eligible, they should be transitioned to Medicaid rather than continuing Marketplace coverage with APTC.
An applicant states they are a lawfully present non-citizen. Which immigration status would make them eligible for Marketplace coverage but NOT for Medicaid/CHIP under the standard 5-year bar?
Answer: Lawful Permanent Resident within their first 5 years in that status
Lawful Permanent Residents are subject to a 5-year waiting period before qualifying for federally funded Medicaid, but they are eligible for Marketplace coverage immediately.
When an applicant is determined eligible for both APTC and cost-sharing reductions, what plan metal level must they select to access CSRs?
Answer: Silver plans only
Cost-sharing reductions are available only when a CSR-eligible consumer enrolls in a Silver-tier plan.