Application Assistance & Enrollment Procedures Flashcards

A consumer submits an application on the last day of open enrollment but makes a payment error. What is the enrollment counselor's best course of action?

Answer: Assist the consumer in correcting the payment error before the deadline passes

Enrollment counselors should assist consumers in resolving payment errors before the enrollment deadline to ensure coverage is secured.

Which document is typically required when a consumer claims a Special Enrollment Period (SEP) due to loss of employer-sponsored coverage?

Answer: Letter from the employer confirming loss of coverage and the date it ended

A letter or notice from the employer documenting coverage termination and the date serves as required proof for an SEP triggered by loss of job-based coverage.

When assisting a consumer with a Marketplace application, what must an enrollment counselor do if the consumer is potentially eligible for Medicaid?

Answer: Screen the consumer for Medicaid eligibility and facilitate a referral to the state Medicaid agency if appropriate

Enrollment counselors must screen for Medicaid/CHIP eligibility and refer consumers to the appropriate state agency when they may qualify.

A family of four applying through the Marketplace includes a non-citizen spouse with a green card. How should the application handle this situation?

Answer: Include the spouse and enter their immigration status; lawfully present immigrants may qualify for coverage

Lawfully present immigrants, including green card holders, are generally eligible for Marketplace coverage and should be included on the household application.

What is the purpose of the 'advance premium tax credit' (APTC) reconciliation process on Form 8962?

Answer: To compare the APTC received during the year with the actual credit amount owed based on final income

Form 8962 reconciles the advance premium tax credits paid on a consumer's behalf with the actual credit they are entitled to based on their final annual income.

During an enrollment session, a consumer asks whether their undocumented family members can be enrolled in a Marketplace plan. What is the correct response?

Answer: Undocumented immigrants are not eligible for Marketplace coverage but should not be included in the household's income calculation for other members' eligibility

Undocumented immigrants are not eligible for Marketplace coverage or subsidies but their income is not counted when determining other household members' eligibility.

A consumer enrolled in a Marketplace plan experiences a qualifying life event mid-year. Within how many days must they generally report the change and enroll in a new plan?

Answer: 60 days

Most qualifying life events trigger a 60-day Special Enrollment Period during which consumers can change or enroll in a new Marketplace plan.