CEC Application Assistance & Enrollment Procedures 5

Question 1

What is the role of a 'Navigator' compared to a certified enrollment counselor in assisting consumers with Marketplace applications?

Accepted Answer

Navigators receive federal grant funding to provide free, unbiased assistance and cannot steer consumers toward specific plans or issuers

Answer

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?

Accepted Answer

Because the employer coverage is considered unaffordable (exceeding the ACA affordability threshold), the consumer may qualify for Marketplace subsidies

Answer

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?

Accepted Answer

Gather all relevant income documentation, ask clarifying questions, and explain how each income type is counted for subsidy purposes

Answer

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?

Accepted Answer

No, Marketplace family plans can only include tax dependents, and a 26-year-old is generally not a tax dependent

Answer

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?

Accepted Answer

Report the income change promptly to the Marketplace so APTC can be adjusted and avoid a large repayment at tax time

Answer

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.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Application Assistance & Enrollment Procedures 5