CEC Eligibility Determination Process 3

Question 1

A consumer is incarcerated but pending disposition of charges. Are they eligible to enroll in a Marketplace plan?

Accepted Answer

Yes, pending disposition of charges they are eligible to enroll

Answer

Individuals incarcerated pending disposition of charges are not excluded from Marketplace eligibility; only those incarcerated post-conviction are excluded.

Question 2

What is the upper income limit (as a percentage of FPL) for eligibility to receive Advance Premium Tax Credits under the ACA for 2024?

Accepted Answer

No upper limit through 2025 under enhanced subsidies

Answer

The American Rescue Plan Act eliminated the 400% FPL cliff through 2025 (extended by the Inflation Reduction Act), so there is no hard upper income limit for APTC.

Question 3

A Marketplace applicant's data-matching issue shows the SSA cannot verify their Social Security number. What is the standard timeline for the consumer to resolve this inconsistency?

Accepted Answer

90 days

Answer

Consumers typically have 90 days to resolve data-matching inconsistencies by submitting documentation to the Marketplace.

Question 4

Which of the following household sizes would place a family at exactly 100% of the 2024 Federal Poverty Level for the contiguous 48 states?

Accepted Answer

Single individual earning $15,060/year

Answer

For 2024, 100% FPL for a single individual in the contiguous 48 states is $15,060.

Question 5

A consumer enrolled mid-year reports a change in income that drops them below 100% FPL. What happens to their APTC eligibility?

Accepted Answer

They may be transitioned to Medicaid if otherwise eligible

Answer

If a consumer's income drops below 100% FPL and they are Medicaid-eligible, they should be transitioned to Medicaid rather than continuing Marketplace coverage with APTC.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Eligibility Determination Process 3