Premium and Cost-Sharing 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 Premium and Cost-Sharing flashcards as text
The advance premium tax credit (APTC) is based on the cost of which benchmark plan?
Answer: Second-lowest-cost Silver plan
APTC is calculated based on the premium of the second-lowest-cost Silver plan available to the household in their area.
Cost-sharing reductions (CSR) on the ACA Marketplace are only available to those who enroll in:
Answer: A Silver plan
CSRs are only applied to Silver plans; eligible individuals with incomes between 100–250% FPL must enroll in a Silver plan to receive the enhanced benefits.
For 2025, the ACA out-of-pocket maximum for an individual in a non-grandfathered plan is approximately:
Answer: $9,200
The ACA sets annual out-of-pocket maximum limits that are adjusted each year; for 2025, the individual limit is $9,200 and family limit is $18,400.
Which income level (as a percentage of the Federal Poverty Level) qualifies for advance premium tax credits in the ACA Marketplace?
Answer: 100–400% FPL
Under current law (extended through 2025), individuals with incomes between 100% and 400% FPL—and above 400% FPL if unaffordable—may qualify for APTCs.
If an enrollee chooses a plan other than the benchmark Silver plan, the APTC amount:
Answer: Stays the same regardless of which plan is selected
The APTC amount is fixed based on the benchmark Silver plan and applied to whichever plan the enrollee selects, covering more of a less expensive plan or less of a more expensive one.
What is the 'family glitch' that was fixed by IRS rules effective 2023?
Answer: Affordability of employer coverage was measured only against the employee's premium, not the family cost
The family glitch referred to the rule that employer coverage was deemed 'affordable' based only on the employee-only premium, leaving dependent family members ineligible for Marketplace subsidies.