CEC Application and Enrollment Procedures 5 — Questions and Answers
Question 1: What is a 'passive renewal' in the context of Marketplace enrollment?
- A consumer actively re-selecting the same plan each year
- Automatic re-enrollment into the same or similar plan if the consumer takes no action during Open Enrollment (Correct answer)
- An insurer automatically upgrading a consumer to a higher-tier plan
- A state-mandated enrollment renewal process
Correct answer: Automatic re-enrollment into the same or similar plan if the consumer takes no action during Open Enrollment
Passive renewal means the Marketplace automatically re-enrolls consumers who do not make an active plan selection during Open Enrollment, often into the same plan.
Question 2: An employer's plan is considered unaffordable under the ACA employer mandate if the employee's share of the premium exceeds what percentage of household income?
- 5% of household income
- 9.02% of household income (2024 indexed figure) (Correct answer)
- 12% of household income
- 15% of household income
Correct answer: 9.02% of household income (2024 indexed figure)
For 2024, a plan is unaffordable if the employee's self-only premium cost exceeds 9.02% of household income, allowing the employee to seek Marketplace subsidies.
Question 3: Which of the following correctly describes cost-sharing reductions (CSRs)?
- They reduce monthly premiums for all metal-tier plans
- They lower deductibles, copays, and out-of-pocket maximums for Silver plan enrollees who qualify by income (Correct answer)
- They are available to any household earning under 400% FPL on any plan tier
- They eliminate all out-of-pocket costs for Medicaid-eligible individuals
Correct answer: They lower deductibles, copays, and out-of-pocket maximums for Silver plan enrollees who qualify by income
CSRs reduce cost-sharing amounts exclusively for Silver plan enrollees whose income falls between 100% and 250% of the Federal Poverty Level.
Question 4: A consumer enrolls in a Marketplace plan on December 20 during Open Enrollment. When does coverage typically begin?
- December 21
- January 1 of the following year (Correct answer)
- February 1 of the following year
- March 1 of the following year
Correct answer: January 1 of the following year
Enrollments completed after the 15th of the month during Open Enrollment typically become effective January 1 of the next plan year.
Question 5: What does MAGI stand for in the context of determining ACA subsidy eligibility?
- Maximum Adjusted Gross Income
- Modified Adjusted Gross Income (Correct answer)
- Minimum Annual Gross Income
- Managed Annual Government Index
Correct answer: Modified Adjusted Gross Income
MAGI, or Modified Adjusted Gross Income, is the income measure used to determine eligibility for Medicaid, CHIP, and Marketplace premium tax credits.
Question 6: Under HIPAA portability rules, what is the maximum pre-existing condition exclusion period a group health plan can impose on a new enrollee who had prior creditable coverage with no gap of more than 63 days?
- 12 months (18 months for late enrollees)
- 6 months
- 24 months
- No exclusion is allowed if there is creditable coverage (Correct answer)
Correct answer: No exclusion is allowed if there is creditable coverage
HIPAA requires that prior creditable coverage without a gap exceeding 63 days offset the pre-existing condition exclusion period, effectively eliminating it for most enrollees.
Question 7: What is the primary responsibility of a Certified Enrollment Counselor when a client asks which specific health plan to choose?
- Recommend the plan with the lowest premium regardless of the client's needs
- Provide objective information about plan options and help the client compare plans based on their own needs and preferences (Correct answer)
- Select the plan for the client without explanation
- Only refer the client to a licensed insurance broker
Correct answer: Provide objective information about plan options and help the client compare plans based on their own needs and preferences
CECs must provide neutral, consumer-centered assistance that helps clients make informed decisions without steering them toward any particular plan.
CEC Application and Enrollment Procedures 5
What is a 'passive renewal' in the context of Marketplace enrollment?