CEC Eligibility Determination Process 5

Question 1

An applicant says they are enrolled in a health care sharing ministry. Does this constitute minimum essential coverage that would disqualify them from APTC?

Accepted Answer

No, health care sharing ministries are not MEC

Answer

Health care sharing ministries do not qualify as minimum essential coverage, so members may still be eligible for Marketplace plans and APTC.

Question 2

A Marketplace consumer notifies the exchange of a new baby born during the plan year. What is the effective date of coverage for the newborn?

Accepted Answer

The date of birth

Answer

Newborns are covered from their date of birth when added to an existing Marketplace plan within the SEP window.

Question 3

A consumer's annual household income is 250% FPL. They qualify for which level of cost-sharing reductions if they enroll in a Silver plan?

Accepted Answer

CSR variant with actuarial value of approximately 87%

Answer

At 200–250% FPL, a Silver CSR plan has an enhanced actuarial value of approximately 87%.

Question 4

Which of the following is a qualifying life event that would open a Special Enrollment Period for an individual who currently has no health coverage?

Accepted Answer

Gaining a dependent through adoption

Answer

Gaining a dependent through adoption, birth, or placement in foster care is a qualifying life event that triggers a SEP.

Question 5

A consumer is determined eligible for Medicaid by the Marketplace and sent to their state Medicaid agency. The state agency later denies eligibility. What option does the consumer have for Marketplace coverage?

Accepted Answer

They receive a SEP to enroll in a Marketplace plan

Answer

A denial of Medicaid or CHIP eligibility triggers a Special Enrollment Period allowing the consumer to enroll in a Marketplace plan.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Eligibility Determination Process 5