CES Premium and Cost-Sharing

Question 1

The advance premium tax credit (APTC) is based on the cost of which benchmark plan?

Accepted Answer

Second-lowest-cost Silver plan

Answer

APTC is calculated based on the premium of the second-lowest-cost Silver plan available to the household in their area.

Question 2

Cost-sharing reductions (CSR) on the ACA Marketplace are only available to those who enroll in:

Accepted Answer

A Silver plan

Answer

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.

Question 3

For 2025, the ACA out-of-pocket maximum for an individual in a non-grandfathered plan is approximately:

Accepted Answer

$9,200

Answer

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.

Question 4

Which income level (as a percentage of the Federal Poverty Level) qualifies for advance premium tax credits in the ACA Marketplace?

Accepted Answer

100–400% FPL

Answer

Under current law (extended through 2025), individuals with incomes between 100% and 400% FPL—and above 400% FPL if unaffordable—may qualify for APTCs.

Question 5

If an enrollee chooses a plan other than the benchmark Silver plan, the APTC amount:

Accepted Answer

Stays the same regardless of which plan is selected

Answer

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.

CES - Certified Enrollment Specialist Practice Test

CES - Certified Enrollment Specialist Practice Test

CES Premium and Cost-Sharing