CEC Premium Tax Credits & Cost-Sharing Reductions

Question 1

What is the Advance Premium Tax Credit (APTC)?

Accepted Answer

A subsidy paid in advance to lower monthly Marketplace premiums

Answer

APTC is a federal subsidy paid directly to insurers in advance to reduce the monthly premium cost for eligible Marketplace enrollees.

Question 2

What income range (as a percentage of the Federal Poverty Level) makes a consumer eligible for the Advance Premium Tax Credit?

Accepted Answer

100–400% FPL

Answer

Consumers with household incomes between 100% and 400% FPL (expanded in some years) are eligible for APTC on the Marketplace.

Question 3

Which metal tier plans are eligible for Cost-Sharing Reductions (CSR)?

Accepted Answer

Silver plans only

Answer

CSR benefits are only available on Silver-tier Marketplace plans, making Silver the only tier where reduced deductibles and copays apply.

Question 4

Which tax form does a consumer receive to reconcile their APTC at tax time?

Accepted Answer

Form 1095-A

Answer

Form 1095-A is the Health Insurance Marketplace Statement that provides the information needed to reconcile APTC when filing federal taxes.

Question 5

What happens when a consumer's actual year-end income is higher than the income they estimated when enrolling?

Accepted Answer

They may owe back some or all of the excess APTC received

Answer

If a consumer's income is higher than estimated, reconciliation on Form 8962 may result in repayment of excess APTC received during the year.

(CEC) Certified Enrollment Counselor Practice Test