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Question 1

What is the income threshold at or below which an individual would typically be directed to Medicaid instead of Marketplace subsidies?

Accepted Answer

138% FPL in Medicaid expansion states

Answer

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.

Question 2

Which individuals are NOT eligible to purchase coverage through the ACA Marketplace?

Accepted Answer

Undocumented immigrants

Answer

Undocumented immigrants are not eligible to purchase Marketplace coverage or receive financial assistance, though they may qualify for emergency Medicaid.

Question 3

What is a 'qualified health plan' (QHP) in the context of the ACA Marketplace?

Accepted Answer

A plan certified by the Marketplace as meeting ACA requirements and offering essential health benefits

Answer

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.

Question 4

When comparing Marketplace plans, the Summary of Benefits and Coverage (SBC) is a standardized document that:

Accepted Answer

Gives a plain-language summary of plan benefits and costs to facilitate comparison

Answer

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.

Question 5

If an applicant's income changes significantly during the plan year, the recommended action is to:

Accepted Answer

Report the income change to the Marketplace promptly to adjust APTC

Answer

Reporting income changes to the Marketplace promptly allows APTC to be adjusted in real time, preventing a large tax repayment at year-end.

CES - Certified Enrollment Specialist Practice Test

CES - Certified Enrollment Specialist Practice Test

CES Marketplace and Exchange Navigation 2