CEC Eligibility Determination Process 4 — Questions and Answers
Question 1: A self-employed individual projects $18,000 in net profit for the year. Which deduction is applied before comparing their income to the FPL for APTC eligibility?
- Standard deduction for their filing status
- One-half of self-employment tax paid (Correct answer)
- Health insurance premiums paid for the family
- Both B and C are deducted from MAGI
Correct answer: One-half of self-employment tax paid
The deduction for one-half of self-employment tax is included in the MAGI calculation as an adjustment to income.
Question 2: A consumer experiences a permanent move to a new service area during the plan year. What type of enrollment opportunity does this trigger?
- No new enrollment opportunity; they must wait for OEP
- A 60-day Special Enrollment Period (Correct answer)
- An immediate auto-enrollment into a comparable plan
- A 30-day grace period only
Correct answer: A 60-day Special Enrollment Period
A permanent move to a new Marketplace service area triggers a 60-day SEP allowing the consumer to select a new plan.
Question 3: Which of the following best describes 'minimum essential coverage' (MEC) that would disqualify a consumer from APTC?
- Any private insurance plan purchased outside the Marketplace
- Medicare Part A or Part B coverage (Correct answer)
- Short-term limited duration insurance
- Excepted benefits such as vision-only or dental-only coverage
Correct answer: Medicare Part A or Part B coverage
Medicare Part A or Part B constitutes minimum essential coverage that makes a consumer ineligible for APTC.
Question 4: A 19-year-old is claimed as a tax dependent by their parent but wishes to enroll in a Marketplace plan separately. Which statement is correct?
- They can enroll independently and receive APTC based on their own income
- They must be included in the parent's Marketplace application
- They are ineligible for any Marketplace coverage as a dependent
- They can enroll separately but APTC is based on the parent's household income (Correct answer)
Correct answer: They can enroll separately but APTC is based on the parent's household income
Tax dependents who enroll separately still have their APTC eligibility determined based on the tax filer's household income, not their own.
Question 5: Under the ACA, what is the maximum percentage of household income a consumer at 150% FPL would be expected to contribute toward the benchmark Silver plan premium after APTC (in 2024)?
- 0% (Correct answer)
- 2%
- 4%
- 6.5%
Correct answer: 0%
Under enhanced subsidies in effect through 2025, consumers at 100–150% FPL pay $0 for the benchmark Silver plan.
Question 6: A Marketplace applicant's employer offers health coverage. The enrollment counselor must assess affordability. For 2024, employer-sponsored coverage is considered unaffordable if the employee-only premium exceeds what percentage of household income?
- 8.39% (Correct answer)
- 9.02%
- 9.5%
- 10%
Correct answer: 8.39%
For 2024, the ACA affordability threshold is 8.39% of household income for the employee-only premium.
Question 7: A consumer who received excess APTC during the year will reconcile the overpayment through which mechanism?
- A bill mailed by the Marketplace after the plan year ends
- IRS Form 8962 filed with their federal tax return (Correct answer)
- Automatic payback deducted from the following year's APTC
- A penalty assessed by the state insurance commissioner
Correct answer: IRS Form 8962 filed with their federal tax return
APTC reconciliation occurs on IRS Form 8962, filed with the federal income tax return for the coverage year.
CEC Eligibility Determination Process 4
A self-employed individual projects $18,000 in net profit for the year.
Which deduction is applied before comparing their income to the FPL for APTC eligibility?