Marketplace and Exchange Navigation Flashcards
6 cards from real CES practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Marketplace and Exchange Navigation flashcards as text
What is the income threshold at or below which an individual would typically be directed to Medicaid instead of Marketplace subsidies?
Answer: 138% FPL in Medicaid expansion states
In states that expanded Medicaid, individuals with income at or below 138% FPL are eligible for Medicaid and not eligible for Marketplace premium tax credits.
Which individuals are NOT eligible to purchase coverage through the ACA Marketplace?
Answer: Undocumented immigrants
Undocumented immigrants are not eligible to purchase Marketplace coverage or receive financial assistance, though they may qualify for emergency Medicaid.
What is a 'qualified health plan' (QHP) in the context of the ACA Marketplace?
Answer: A plan certified by the Marketplace as meeting ACA requirements and offering essential health benefits
A QHP is a health insurance plan certified by the Marketplace, meeting ACA standards including coverage of essential health benefits, minimum actuarial value, and other requirements.
When comparing Marketplace plans, the Summary of Benefits and Coverage (SBC) is a standardized document that:
Answer: Gives a plain-language summary of plan benefits and costs to facilitate comparison
The SBC is a standardized, easy-to-read four-page document required by the ACA that summarizes a plan's benefits, cost-sharing, and coverage limits for comparison shopping.
If an applicant's income changes significantly during the plan year, the recommended action is to:
Answer: Report the income change to the Marketplace promptly to adjust APTC
Reporting income changes to the Marketplace promptly allows APTC to be adjusted in real time, preventing a large tax repayment at year-end.
The Basic Health Program (BHP) is an optional state program that serves individuals with incomes between:
Answer: 100–200% FPL
The BHP allows states to offer more stable, lower-cost coverage to residents with incomes between 100–200% FPL who would otherwise be in the Marketplace.