CES Premium and Cost-Sharing 3

Question 1

When reconciling APTC at tax time, what happens if an enrollee's actual income was higher than estimated?

Accepted Answer

They must repay some or all excess advance credits received

Answer

If actual annual income exceeds the estimate, the enrollee must repay excess APTC when filing taxes, subject to annual repayment caps based on income.

Question 2

Which of the following is NOT included in the ACA definition of a 'cost-sharing' reduction?

Accepted Answer

Monthly premium

Answer

Cost-sharing refers to the enrollee's share of covered service costs including deductibles, copayments, and coinsurance; monthly premiums are a separate category.

Question 3

For self-funded (self-insured) employer plans, which ACA cost-sharing provisions still apply?

Accepted Answer

Out-of-pocket maximums and preventive care no-cost-sharing apply

Answer

Non-grandfathered self-funded plans must comply with ACA requirements including the out-of-pocket maximum limit and no cost-sharing for preventive services.

Question 4

The 'cliff' in the ACA subsidy structure historically referred to the situation where income just above 400% FPL resulted in:

Accepted Answer

Complete loss of all premium tax credits

Answer

Prior to 2021, the ACA subsidy cliff meant that household income just above 400% FPL caused complete loss of premium tax credits, sometimes resulting in thousands of dollars more in premiums.

Question 5

Embedded versus aggregate deductibles primarily affect families because with an aggregate deductible:

Accepted Answer

The entire family deductible must be met collectively before any one member receives coverage beyond cost-sharing

Answer

An aggregate deductible means the family must collectively reach the full family deductible amount before any member receives the plan's coverage for non-preventive services.

CES - Certified Enrollment Specialist Practice Test

CES - Certified Enrollment Specialist Practice Test

CES Premium and Cost-Sharing 3