CES Cheat Sheet 2026

The 30 highest-yield CES facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. When an employer changes the annual open enrollment period, employees who didn't previously elect coverage may: → Enroll during the new enrollment period even without a life event
2. What is the primary difference between a copayment and coinsurance? → A copayment is a fixed dollar amount; coinsurance is a percentage of the allowed amount
3. If an enrollee chooses a plan other than the benchmark Silver plan, the APTC amount: → Stays the same regardless of which plan is selected
4. When a health plan covers preventive services at 100% with no cost-sharing, this requirement comes from: → The Affordable Care Act (ACA)
5. A catastrophic health plan is available primarily to which group? → Adults under age 30 or those with hardship exemptions
6. A person gaining Medicaid eligibility triggers which type of enrollment opportunity? → Immediate enrollment in Medicaid with no waiting period
7. Which of the following is NOT included in the ACA definition of a 'cost-sharing' reduction? → Monthly premium
8. A Navigator is a federally funded, certified professional who may: → Provide unbiased enrollment assistance at no cost to consumers
9. A hardship Special Enrollment Period in the Marketplace may be granted for situations such as: → Experiencing a natural disaster that made obtaining coverage difficult
10. What is the formal statutory name for CHIP, as established by the Balanced Budget Act of 1997? → Title XXI of the Social Security Act
11. Which document helps ensure you are following correct procedures? → Program policy manual
12. When an FSA is described as 'use it or lose it,' this refers to: → The requirement to spend FSA funds within the plan year or forfeit unused amounts
13. What role does body language play in customer service? → Reinforces trust and professionalism
14. Which of the following is NOT typically considered a qualified medical expense for an HSA? → Health insurance premiums (most circumstances)
15. Having a baby triggers a Special Enrollment Period. The SEP window begins: → The day of birth and lasts 60 days
16. What is the primary role of the Health Insurance Marketplace created by the ACA? → To offer a platform where individuals can compare and purchase qualified health plans
17. Which federal agency administers Medicaid and CHIP at the federal level? → Centers for Medicare & Medicaid Services (CMS)
18. Under the ACA, which metal tier plan covers approximately 80% of expected healthcare costs on average? → Gold
19. What should an Enrollment Specialist do if key documents are missing? → Notify the client to resubmit with full documents
20. What should you do if you suspect a compliance violation? → Inform a supervisor or compliance officer
21. An individual who loses employer-sponsored coverage due to job loss may use a Marketplace SEP. The SEP is triggered: → When employer coverage is lost regardless of COBRA eligibility
22. If an applicant's income changes significantly during the plan year, the recommended action is to: → Report the income change to the Marketplace promptly to adjust APTC
23. What is the minimum value standard for employer-sponsored health insurance under the ACA? → 60% actuarial value
24. A plan's 'allowed amount' (also called 'negotiated rate') is important for cost-sharing because: → Coinsurance is calculated as a percentage of the allowed amount, not the billed charge
25. In a Federally Facilitated Marketplace state, the plan selection interface for consumers is hosted at: → HealthCare.gov
26. Cost-sharing reductions (CSR) improve coverage for eligible individuals by: → Lowering deductibles, copayments, and out-of-pocket maximums within a Silver plan
27. What does PPO stand for in health insurance? → Preferred Provider Organization
28. What documentation is typically required when claiming a SEP based on loss of prior coverage? → A termination letter or letter from prior insurer confirming coverage end date
29. What does COBRA stand for? → Consolidated Omnibus Budget Reconciliation Act
30. What is a common tool for monitoring compliance? → Internal audits