CEC Health Coverage Options & Program Eligibility 2

Question 1

A 35-year-old single adult with no dependents has income at 140% FPL. Which program is most appropriate?

Accepted Answer

Medicaid (in expansion states)

Answer

In states that expanded Medicaid, adults with income up to 138% FPL qualify, but 140% FPL falls just above the threshold, so a Marketplace plan with APTC is correct.

Question 2

Which of the following is NOT a qualifying life event that triggers a Special Enrollment Period?

Accepted Answer

Voluntarily dropping coverage

Answer

Voluntarily dropping coverage is not a qualifying life event; SEPs are triggered by involuntary loss of coverage or life changes like marriage or birth.

Question 3

Under the ACA, which metal tier plan has the highest actuarial value?

Accepted Answer

Platinum

Answer

Platinum plans have the highest actuarial value at approximately 90%, meaning the plan pays 90% of covered costs on average.

Question 4

A consumer's employer offers coverage that costs 12% of their household income. How does this affect Marketplace eligibility?

Accepted Answer

They are eligible for Marketplace APTC because the offer is unaffordable

Answer

Employer-sponsored coverage is considered unaffordable if the employee-only premium exceeds 9.02% (2023 threshold) of household income, making the consumer eligible for Marketplace subsidies.

Question 5

Which federal program provides health coverage specifically to low-income pregnant women who do not otherwise qualify for Medicaid?

Accepted Answer

CHIP Perinatal

Answer

CHIP Perinatal (or unborn child option) allows states to extend CHIP coverage to unborn children of low-income women who don't qualify for Medicaid.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Health Coverage Options & Program Eligibility 2