CEC Health Coverage Options & Program Eligibility 3 — Questions and Answers
Question 1: A family of 4 earns $45,000/year. In 2024, the FPL for a family of 4 is approximately $31,200. What percentage of FPL is this family's income?
- 112% FPL
- 144% FPL (Correct answer)
- 188% FPL
- 211% FPL
Correct answer: 144% FPL
$45,000 ÷ $31,200 ≈ 144% FPL, placing them in the range for Marketplace subsidies and potentially cost-sharing reductions on a Silver plan.
Question 2: Cost-sharing reductions (CSRs) on the Marketplace are available only when a consumer enrolls in which metal tier?
- Bronze
- Silver (Correct answer)
- Gold
- Any metal tier
Correct answer: Silver
CSRs are only available on Silver plans; enrolling in any other metal tier forfeits the cost-sharing reduction benefit even if income qualifies.
Question 3: Which of the following individuals is categorically excluded from Marketplace coverage?
- A 25-year-old on a parent's plan who also wants their own plan
- An undocumented immigrant (Correct answer)
- A retiree under 65 not yet on Medicare
- A self-employed person with no employer offer
Correct answer: An undocumented immigrant
Undocumented immigrants are not eligible to enroll in Marketplace plans or receive premium tax credits under the ACA.
Question 4: Medicare Part D covers which type of healthcare service?
- Hospital inpatient stays
- Outpatient physician visits
- Prescription drugs (Correct answer)
- Dental and vision
Correct answer: Prescription drugs
Medicare Part D is the voluntary prescription drug benefit program, available through stand-alone PDP plans or Medicare Advantage plans with drug coverage.
Question 5: An enrollment counselor is helping a 67-year-old who has both Medicare and Medicaid. What is this called?
- CHIP beneficiary
- Dual eligible (Correct answer)
- Extra Help recipient
- Benchmark plan enrollee
Correct answer: Dual eligible
Individuals who qualify for both Medicare and Medicaid are called 'dual eligibles' and may receive coordinated benefits from both programs.
Question 6: Which statement about COBRA continuation coverage is accurate?
- Premiums are fully paid by the former employer
- Coverage can last indefinitely
- The individual pays up to 102% of the full premium (Correct answer)
- COBRA is only available for plans with fewer than 20 employees
Correct answer: The individual pays up to 102% of the full premium
Under COBRA, the individual pays the full premium (both employee and employer shares) plus a 2% administrative fee, making it often expensive.
Question 7: What is the primary purpose of a Health Savings Account (HSA)?
- To pay Medicare Part B premiums
- To save pre-tax dollars for qualified medical expenses when paired with an HDHP (Correct answer)
- To receive government subsidies for Marketplace plans
- To fund COBRA premiums only
Correct answer: To save pre-tax dollars for qualified medical expenses when paired with an HDHP
An HSA allows individuals enrolled in a High-Deductible Health Plan to save pre-tax money for qualified medical expenses, reducing overall tax liability.
CEC Health Coverage Options & Program Eligibility 3
A family of 4 earns $45,000/year.
In 2024, the FPL for a family of 4 is approximately $31,200.
What percentage of FPL is this family's income?