CEC Application and Enrollment Procedures 4

Question 1

What is the maximum length of a COBRA continuation coverage period for a qualifying event of termination of employment?

Accepted Answer

18 months

Answer

COBRA provides up to 18 months of continuation coverage for qualifying events such as voluntary or involuntary job loss.

Question 2

An applicant is unsure whether their household qualifies for Medicaid or a Marketplace plan. What should the enrollment counselor do?

Accepted Answer

Screen the applicant's income against FPL guidelines to determine the appropriate program

Answer

Counselors should compare the household's modified adjusted gross income to the Federal Poverty Level thresholds to determine Medicaid versus Marketplace eligibility.

Question 3

Under the ACA, what is the maximum out-of-pocket limit for an individual in a plan year for in-network services?

Accepted Answer

$9,450 (2024 figure; indexed annually)

Answer

The ACA sets an annual out-of-pocket maximum that is indexed each year; for 2024 it is $9,450 for individual coverage.

Question 4

Which metal tier plan has the highest actuarial value under ACA Marketplace rules?

Accepted Answer

Platinum

Answer

Platinum plans have the highest actuarial value of approximately 90%, meaning the plan pays about 90% of covered costs on average.

Question 5

A consumer wants to enroll in a Marketplace plan after losing Medicaid eligibility. Which SEP applies?

Accepted Answer

Loss-of-minimum-essential-coverage SEP

Answer

Loss of Medicaid qualifies as a loss of minimum essential coverage, triggering a Special Enrollment Period for Marketplace plans.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Application and Enrollment Procedures 4