CEC Application Assistance & Enrollment Procedures 5 — Questions and Answers
Question 1: What is the role of a 'Navigator' compared to a certified enrollment counselor in assisting consumers with Marketplace applications?
- Navigators are licensed insurance agents who earn commissions; counselors are volunteers
- Navigators receive federal grant funding to provide free, unbiased assistance and cannot steer consumers toward specific plans or issuers (Correct answer)
- Navigators can only assist Medicare beneficiaries
- Navigators are only authorized to assist in rural areas
Correct answer: Navigators receive federal grant funding to provide free, unbiased assistance and cannot steer consumers toward specific plans or issuers
Navigators are federally funded to provide neutral, no-cost enrollment assistance and are prohibited from recommending specific plans or receiving compensation from insurers.
Question 2: A consumer's employer offers coverage that costs 12% of the employee's household income. How does this affect their Marketplace subsidy eligibility?
- They are fully eligible for Marketplace subsidies regardless of employer offer
- Because the employer coverage is considered unaffordable (exceeding the ACA affordability threshold), the consumer may qualify for Marketplace subsidies (Correct answer)
- Employer coverage always makes a consumer ineligible for subsidies
- The 12% threshold has no bearing on subsidy eligibility
Correct answer: Because the employer coverage is considered unaffordable (exceeding the ACA affordability threshold), the consumer may qualify for Marketplace subsidies
Employer-sponsored coverage is considered unaffordable if the employee's share of the self-only premium exceeds the ACA's affordability threshold, making the employee potentially eligible for Marketplace subsidies.
Question 3: When assisting a consumer with a complex household situation involving multiple income sources, what is the enrollment counselor's best practice?
- Estimate income based on last year's tax return without asking further questions
- Gather all relevant income documentation, ask clarifying questions, and explain how each income type is counted for subsidy purposes (Correct answer)
- Only count W-2 wages and ignore self-employment income
- Tell the consumer to use zero income to maximize subsidies
Correct answer: Gather all relevant income documentation, ask clarifying questions, and explain how each income type is counted for subsidy purposes
Best practice requires collecting comprehensive income information and explaining how different income types (wages, self-employment, Social Security, etc.) factor into the MAGI calculation.
Question 4: A consumer wants to enroll their 26-year-old child on their Marketplace family plan. Is this permitted under ACA rules?
- Yes, adult children up to age 30 can be covered on a parent's plan
- No, Marketplace family plans can only include tax dependents, and a 26-year-old is generally not a tax dependent (Correct answer)
- Yes, adult children of any age can be added to a parent's Marketplace plan
- No, adult children must always have their own separate plan
Correct answer: No, Marketplace family plans can only include tax dependents, and a 26-year-old is generally not a tax dependent
Marketplace family plans cover tax dependents; a 26-year-old who is not a tax dependent of the parent cannot be included on the parent's Marketplace application.
Question 5: What is the correct procedure when a consumer reports a change in income mid-year that would significantly reduce their APTC eligibility?
- Wait until tax filing to reconcile without updating the Marketplace
- Report the income change promptly to the Marketplace so APTC can be adjusted and avoid a large repayment at tax time (Correct answer)
- Cancel the plan and re-enroll with the new income
- Increase APTC amount to compensate for higher income
Correct answer: Report the income change promptly to the Marketplace so APTC can be adjusted and avoid a large repayment at tax time
Consumers should report income changes to the Marketplace promptly so APTC is adjusted, reducing the risk of owing a large repayment when reconciling on Form 8962.
Question 6: A consumer is self-employed with variable income. What is the recommended approach for estimating income on the Marketplace application?
- Use the highest income month multiplied by 12
- Use the best estimate of annual net self-employment income, considering seasonal fluctuations, and report changes to the Marketplace as income becomes clearer (Correct answer)
- Leave the income field blank and let the Marketplace decide
- Use last year's gross income without adjustment
Correct answer: Use the best estimate of annual net self-employment income, considering seasonal fluctuations, and report changes to the Marketplace as income becomes clearer
Self-employed consumers should provide their best annual income estimate based on expected net earnings and update the Marketplace as income becomes clearer throughout the year.
Question 7: Which of the following best describes the enrollment counselor's obligation regarding consumer privacy when handling application information?
- Consumer information may be shared freely with other agencies to streamline enrollment
- Enrollment counselors must safeguard all consumer information, use it only for authorized purposes, and comply with federal and state privacy laws (Correct answer)
- Privacy rules only apply to health information, not financial information collected during enrollment
- Counselors are not bound by privacy requirements since they are volunteers
Correct answer: Enrollment counselors must safeguard all consumer information, use it only for authorized purposes, and comply with federal and state privacy laws
Enrollment counselors are obligated to protect all consumer information—including financial and health data—under federal privacy laws and their certification requirements.
CEC Application Assistance & Enrollment Procedures 5
What is the role of a 'Navigator' compared to a certified enrollment counselor in assisting consumers with Marketplace applications?