CEC ACA & Marketplace Fundamentals 5

Question 1

Under the ACA's guaranteed issue requirement, insurers in the individual Marketplace must:

Accepted Answer

Accept all applicants regardless of health status during open or special enrollment periods

Answer

Guaranteed issue prohibits Marketplace insurers from denying coverage or charging more based on health status during enrollment periods.

Question 2

What is the role of the risk corridor program established under the ACA?

Accepted Answer

To limit insurer losses or gains during the first years of Marketplace operation

Answer

Risk corridors were a temporary program designed to stabilize insurer profits/losses in the first three years of ACA Marketplace operation (2014-2016).

Question 3

A consumer enrolling on November 20 during Open Enrollment selects a plan. When does their coverage begin if no earlier start date applies?

Accepted Answer

January 1 of the following year

Answer

Enrollments completed between December 16 and January 15 have a February 1 effective date, but a November 20 enrollment results in a January 1 effective date.

Question 4

Which of the following is a permissible rating factor that insurers may use to vary premiums in ACA Marketplace plans?

Accepted Answer

Age (within a 3:1 ratio limit)

Answer

The ACA allows insurers to vary premiums based on age (up to 3:1 ratio), tobacco use, family size, and geographic area, but prohibits gender and health status rating.

Question 5

What income threshold (as a percentage of FPL) must an individual be at or above to be eligible for Marketplace premium tax credits rather than Medicaid?

Accepted Answer

100% FPL in non-expansion states; 138% FPL in expansion states

Answer

In Medicaid expansion states, APTC eligibility starts at 138% FPL; in non-expansion states, it starts at 100% FPL because those below 138% have no Medicaid option.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC ACA & Marketplace Fundamentals 5