CEC Premium Tax Credits & Cost-Sharing Reductions 2

Question 1

Cost-Sharing Reductions (CSR) lower which of the following for eligible consumers?

Accepted Answer

Deductibles, copayments, and out-of-pocket maximums

Answer

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?

Accepted Answer

The Marketplace based on application data

Answer

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?

Accepted Answer

100% FPL

Answer

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?

Accepted Answer

Silver

Answer

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?

Accepted Answer

Comparing APTC received to the actual credit owed based on final income

Answer

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.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Premium Tax Credits & Cost-Sharing Reductions 2