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Marketplace and Exchange Navigation Flashcards

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  1. What is the primary role of the Health Insurance Marketplace created by the ACA?

    Answer: To offer a platform where individuals can compare and purchase qualified health plans

    The Health Insurance Marketplace is a structured platform where consumers can shop, compare, and enroll in ACA-compliant qualified health plans and apply for financial assistance.

  2. States that choose to run their own ACA exchange are called:

    Answer: State-Based Marketplaces (SBMs)

    States that build and operate their own ACA-compliant exchanges are called State-Based Marketplaces (SBMs), while other states use HealthCare.gov.

  3. A Navigator is a federally funded, certified professional who may:

    Answer: Provide unbiased enrollment assistance at no cost to consumers

    Navigators are federally funded, trained, and certified to provide free, unbiased help with Marketplace applications, enrollment, and plan comparison without selling plans.

  4. Which of the following must an applicant provide to apply for Marketplace coverage?

    Answer: Household size and estimated annual income

    Marketplace applications require household information including size, income estimate, citizenship or immigration status, and Social Security numbers to determine eligibility for plans and financial assistance.

  5. The SHOP (Small Business Health Options Program) Marketplace is designed for:

    Answer: Small employers with generally 1–50 employees

    SHOP is the ACA Marketplace for small businesses, generally those with 1–50 full-time equivalent employees, allowing them to offer employees a choice of QHPs.

  6. A Certified Application Counselor (CAC) differs from a Navigator primarily because CACs are:

    Answer: Certified by CMS-approved organizations (such as hospitals or community clinics) rather than federally funded

    CACs are trained and certified through CMS-approved organizations such as hospitals, FQHCs, and community centers, while Navigators receive federal grant funding.