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 consumer loses job-based coverage on March 15. How long do they have to enroll in a Marketplace plan using their SEP?
Answer: 60 days from the loss
Consumers who lose qualifying coverage have a 60-day SEP window to enroll in a Marketplace plan before or after the qualifying event.
Which of the following best describes the 'Medicaid gap' problem in non-expansion states?
Answer: Adults earn too much for Marketplace subsidies but too little to qualify
In non-expansion states, adults with income below 100% FPL don't qualify for Marketplace APTCs (which start at 100% FPL) and may not qualify for Medicaid, leaving them in a 'coverage gap.'
Which Medicare part covers outpatient services, including doctor visits and preventive care?
Answer: Part B
Medicare Part B covers medically necessary outpatient services, preventive services, and durable medical equipment.
Under the ACA, children may remain on a parent's health plan until what age?
Answer: 26
The ACA requires health plans that offer dependent coverage to allow adult children to remain on a parent's plan until age 26, regardless of marital or student status.
Which of the following is a characteristic of a Preferred Provider Organization (PPO)?
Answer: Allows out-of-network coverage at a higher cost
PPOs allow members to see out-of-network providers at a higher cost-sharing level without needing a referral, offering greater flexibility than HMOs.
What income threshold generally determines CHIP eligibility for children in most states?
Answer: Up to 200%–300% FPL (varies by state)
CHIP eligibility for children typically covers households earning too much for Medicaid but generally up to 200–300% FPL, with variation by state.
A consumer enrolls in a Marketplace plan and later receives a higher-paying job mid-year. What should they do?
Answer: Report the income change to the Marketplace promptly to adjust APTC
Consumers must report income changes promptly so the Marketplace can adjust their APTC; failure to do so may result in repayment of excess credits at tax time.