CEC Premium Tax Credits & Cost-Sharing Reductions 2 — Questions and Answers
Question 1: Cost-Sharing Reductions (CSR) lower which of the following for eligible consumers?
- Monthly premiums
- Deductibles, copayments, and out-of-pocket maximums (Correct answer)
- Annual enrollment fees
- Federal income taxes
Correct answer: Deductibles, copayments, and out-of-pocket maximums
CSR reduces cost-sharing amounts such as deductibles, copays, and out-of-pocket maximums for eligible consumers enrolled in Silver plans.
Question 2: Who calculates the amount of APTC a consumer is eligible to receive?
- The consumer's insurance agent
- The Marketplace based on application data (Correct answer)
- The consumer's employer
- The IRS before Open Enrollment
Correct answer: The Marketplace based on application data
The Health Insurance Marketplace calculates APTC eligibility based on the consumer's household income and size information provided on the application.
Question 3: What is the minimum income level (as % FPL) required for APTC eligibility in states without Medicaid expansion?
- 50% FPL
- 100% FPL (Correct answer)
- 133% FPL
- 138% FPL
Correct answer: 100% FPL
In non-Medicaid-expansion states, consumers at 100% FPL and above may qualify for APTC if they are not eligible for other minimum essential coverage.
Question 4: A consumer who qualifies for Cost-Sharing Reductions must enroll in which metal tier to receive the benefit?
- Bronze
- Silver (Correct answer)
- Gold
- Platinum
Correct answer: Silver
CSR benefits are only applied to Silver-tier plans; enrolling in any other tier forfeits the cost-sharing reduction benefit.
Question 5: What is 'reconciliation' in the context of the Advance Premium Tax Credit?
- The process of switching plans mid-year
- Comparing APTC received to the actual credit owed based on final income (Correct answer)
- Renewing enrollment for the next plan year
- Verifying a consumer's identity with the Marketplace
Correct answer: Comparing APTC received to the actual credit owed based on final income
Reconciliation is the process on Form 8962 where the APTC paid throughout the year is compared against the actual premium tax credit based on final reported income.
Question 6: Which consumers are NOT eligible for premium tax credits on the Marketplace?
- Self-employed individuals earning 200% FPL
- Part-time workers without employer coverage
- Individuals eligible for affordable employer-sponsored insurance (Correct answer)
- Retirees under age 65 with no Medicare
Correct answer: Individuals eligible for affordable employer-sponsored insurance
Consumers who are offered affordable, minimum-value employer-sponsored insurance are not eligible for APTC, even if they choose not to enroll in the employer plan.
CEC Premium Tax Credits & Cost-Sharing Reductions 2
Cost-Sharing Reductions (CSR) lower which of the following for eligible consumers?