Health Coverage Options & Program Eligibility 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 Health Coverage Options & Program Eligibility flashcards as text
A 35-year-old single adult with no dependents has income at 140% FPL. Which program is most appropriate?
Answer: Medicaid (in expansion states)
In states that expanded Medicaid, adults with income up to 138% FPL qualify, but 140% FPL falls just above the threshold, so a Marketplace plan with APTC is correct.
Which of the following is NOT a qualifying life event that triggers a Special Enrollment Period?
Answer: Voluntarily dropping coverage
Voluntarily dropping coverage is not a qualifying life event; SEPs are triggered by involuntary loss of coverage or life changes like marriage or birth.
Under the ACA, which metal tier plan has the highest actuarial value?
Answer: Platinum
Platinum plans have the highest actuarial value at approximately 90%, meaning the plan pays 90% of covered costs on average.
A consumer's employer offers coverage that costs 12% of their household income. How does this affect Marketplace eligibility?
Answer: They are eligible for Marketplace APTC because the offer is unaffordable
Employer-sponsored coverage is considered unaffordable if the employee-only premium exceeds 9.02% (2023 threshold) of household income, making the consumer eligible for Marketplace subsidies.
Which federal program provides health coverage specifically to low-income pregnant women who do not otherwise qualify for Medicaid?
Answer: CHIP Perinatal
CHIP Perinatal (or unborn child option) allows states to extend CHIP coverage to unborn children of low-income women who don't qualify for Medicaid.
What is the income range for premium tax credit eligibility on the Marketplace (after the ARP 2021 expansions made permanent)?
Answer: 100% FPL and above with no upper cap
Under the Inflation Reduction Act, the upper income cap on APTC was eliminated; anyone above 100% FPL (400%+ FPL) may qualify if premiums exceed the benchmark percentage of income.
A consumer who is lawfully present in the US but has been here fewer than 5 years on a qualified immigration status is applying for Medicaid. What is the general rule?
Answer: They must wait 5 years before qualifying for full Medicaid
Most lawfully present immigrants must satisfy a 5-year waiting period before being eligible for federally funded Medicaid, though some exceptions apply (e.g., refugees, pregnant women in some states).