CEC ACA & Marketplace Fundamentals 3 — Questions and Answers
Question 1: A 35-year-old applicant earns 150% of FPL and qualifies for Medicaid in an expansion state. What should an enrollment counselor advise?
- Enroll in a Bronze Marketplace plan
- Apply for Medicaid immediately (Correct answer)
- Use a Catastrophic plan instead
- Wait until Open Enrollment
Correct answer: Apply for Medicaid immediately
Individuals who qualify for Medicaid should apply for Medicaid, as they cannot receive premium tax credits if they are eligible for Medicaid.
Question 2: What is the annual Open Enrollment Period (OEP) for individual Marketplace coverage for the 2024 plan year?
- October 1 – December 15, 2023
- November 1 – January 15, 2024 (Correct answer)
- November 1 – December 15, 2023
- October 15 – December 7, 2023
Correct answer: November 1 – January 15, 2024
The 2024 OEP ran from November 1, 2023 through January 15, 2024, with coverage starting January 1 for enrollments completed by December 15.
Question 3: Which of the following qualifying life events triggers a Special Enrollment Period?
- Voluntarily canceling prior health coverage
- Moving to a new county with different plan options (Correct answer)
- Choosing to retire early before age 65
- Being diagnosed with a chronic illness
Correct answer: Moving to a new county with different plan options
Moving to a new service area with different Marketplace plan options is a qualifying life event that triggers a 60-day Special Enrollment Period.
Question 4: The Advance Premium Tax Credit (APTC) is paid directly to whom?
- The enrollee as a tax refund
- The health insurance company on the enrollee's behalf (Correct answer)
- CMS for deposit into a federal fund
- The enrollee's employer
Correct answer: The health insurance company on the enrollee's behalf
APTC is paid directly to the insurance company, reducing the enrollee's monthly premium amount owed.
Question 5: A Catastrophic health plan on the Marketplace is available only to individuals who are:
- Under age 30 or have a hardship/affordability exemption (Correct answer)
- Under age 35 and earning below 200% FPL
- Any age if they choose the lowest premium plan
- Eligible for Medicare but not yet enrolled
Correct answer: Under age 30 or have a hardship/affordability exemption
Catastrophic plans are limited to individuals under 30 or those who qualify for a hardship or affordability exemption.
Question 6: What happens if an enrollee's income is higher than estimated at the end of the tax year and they received too much APTC?
- Nothing; the IRS forgives the overpayment automatically
- They must repay some or all of the excess APTC when filing taxes (Correct answer)
- Their plan is retroactively canceled
- CMS bills the insurer for the difference
Correct answer: They must repay some or all of the excess APTC when filing taxes
Excess APTC must be reconciled on the enrollee's federal tax return, and they may owe repayment of some or all of the overpaid credit.
Question 7: Which of the following is considered Minimum Essential Coverage (MEC) under the ACA?
- Short-term health plans
- Excepted benefit dental-only plans
- Employer-sponsored group health plans (Correct answer)
- Vision-only insurance
Correct answer: Employer-sponsored group health plans
Employer-sponsored group health plans that meet ACA standards qualify as Minimum Essential Coverage.
CEC ACA & Marketplace Fundamentals 3
A 35-year-old applicant earns 150% of FPL and qualifies for Medicaid in an expansion state.
What should an enrollment counselor advise?