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0 This content is valid through July 2021.
Topic: 1 of 7: Welcome to the Individual Marketplace Review for
Returning Agents and Brokers Page: 1 of 4: Welcome to the
Individual Marketplace Review for Returning Agents and Brokers
Long Description Animated introduction screen containing the
following text at the top and left of the screen: Welcome to the
Individual Marketplace Review for Returning Agents and Brokers.
Beneath this text on the left is the logo for the Department of
Health & Human Services (HHS), which is made up of the profiles
of people, stacked on top of each other, resulting in the profile
of an eagle. The words "Department of Health & Human Services
USA" form a circle that extends out and to the left from the
profiles. To the right of the logo are the words “Health Insurance
Marketplace®.” On the right side of the screen are three images
from the module representing agents and brokers and module-specific
concepts.
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1 This content is valid through July 2021.
Page: 2 of 4: Disclaimer
Page Text The information in this training was current at the
time it was published or uploaded onto the Web. Eligibility
policies and Marketplace requirements may change so links to the
source documents have been provided within the document for your
reference. This training is not intended to grant rights or impose
obligations. It may contain references or links to statutes,
regulations, or other policy materials. The information provided is
only intended to be a general summary. It is not intended to take
the place of either the written law or regulations. We encourage
learners to review the specific statutes, regulations, and other
interpretive materials for a full and accurate statement of the
requirements. This communication was printed, published, or
produced and disseminated at U.S. taxpayer expense. Alt Text A page
of text with horizontal lines across it; a red horizontal box
containing the word "Disclaimer" within it
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Page: 3 of 4: Introduction
Page Text Welcome to the Individual Marketplace Review for
Returning Agents and Brokers. This training should take about 40
minutes to complete. During this this review, you will: • Review
the eligibility criteria for individuals to enroll in a qualified
health plan (QHP) through the Health Insurance
Marketplace®* • Review the rules for QHP enrollment for
individuals eligible for Medicare, Medicaid, or the Children’s
Health Insurance
Program (CHIP) and individuals with employer-sponsored coverage
• Review how to assist consumers with submitting information or
taking action in response to a notification that they need to
resolve a data matching issue • Review the eligibility
requirements for advance payments of the premium tax credit (APTC)
and cost-sharing reductions
(CSRs) • Review the enrollment periods and coverage effective
dates available through the Marketplace • Review the enrollment
pathways available to agents and brokers, as well as tips for
ensuring an agent’s or broker’s
National Producer Number (NPN) is recorded and retained when
assisting with consumer enrollments * The term "Health Insurance
Marketplace®" is a registered trademark of the U.S. Department of
Health & Human Services (HHS). When used in this document, the
term “Health Insurance Marketplace®” or “Marketplace” refers to
Federally-facilitated Marketplaces (FFMs), including FFMs where
states perform plan management functions, and also refers to
State-based Marketplaces on the Federal Platform (SBM-FPs).
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3 This content is valid through July 2021.
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semi-translucent screen with her index finger pressing an icon of a
magnifying glass that represents a computer search feature
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Page: 4 of 4: Structure and Navigation
Page Text This training contains a bookmarking feature that
allows you to stop at any point and return later to continue where
you left off. To successfully complete this review, you must
complete each of the following scenarios:
1. Scenario 1: Eligibility Criteria for Enrolling in a QHP 2.
Scenario 2: Helping Consumers Resolve a Data Matching Issue 3.
Scenario 3: Eligibility for Financial Assistance Through the
Marketplace 4. Scenario 4: Open Enrollment Period and Special
Enrollment Periods 5. Scenario 5: Enrollment Pathways and Recording
Your NPN on Applications 6. Key Points
Training Navigation
• Selecting Back takes you to the previous page. • Selecting
Next takes you to the next page. • Selecting Menu takes you to the
menu page and provides access to any of the topics. • Selecting
Help displays information about accessibility and functionality. •
Selecting Glossary displays a list of terms and acronyms used. •
Selecting Exit closes the training.
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Alt Text A road post with signs pointing in different
directions; each sign contains a specific topic title from this
lesson (Scenario 1, Scenario 2, etc.).
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Topic: 2 of 7: Scenario 1: Eligibility Criteria for Enrolling in
a QHP Page: 1 of 6: Scenario 1: Narrative
Page Text Shanika Miller, 25, lives in Tampa, Florida, with her
parents, Malik and Kayla, and her sister, Jada, who is 16 years
old. Malik is 65 years old and is retiring soon from his job for
the past 38 years in hotel housekeeping. Kayla is 52 years old and
is unemployed due to a disability. Shanika has health coverage for
herself through a health plan sponsored by her employer, but she is
reaching out to you wondering whether members of her family can
apply for health coverage through the Marketplace. Alt Text A woman
with her arms crossed in front of her body; her right hand is
beneath her chin and her left hand is supporting her right
elbow.
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Page: 2 of 6: Scenario 1: Question 1
Prompt Select the best answer and then click Check Your Answer.
Question Shanika asks whether there are any specific criteria that
individuals have to meet in order to be eligible to obtain
insurance through the Marketplace. How do you answer Shanika’s
question? Options
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A. There are three criteria individuals must meet: (1) Be
residents of the state where they will apply for coverage and
enroll in a QHP; (2) Be U.S. citizens or nationals, or lawfully
present non-citizens, and expect to remain so for the entire period
coverage is sought; and (3) Not be incarcerated, other than
incarceration pending the disposition of charges.
B. There are three criteria individuals must meet: (1) Be
residents of the state where they will apply for coverage and
enroll in a QHP; (2) Be U.S. citizens or nationals, or lawfully
present non-citizens, and expect to remain so for the entire period
coverage is sought; and (3) Not have health coverage for at least
one year.
C. There are three criteria individuals must meet: (1) Be
residents of the state where they will apply for coverage and
enroll in a QHP; (2) Be employed for at least one year in the state
where they will apply for coverage and enroll in a QHP; and (3) Not
be incarcerated, other than incarceration pending the disposition
of charges.
Correct Answer A Positive Feedback You are right! These are the
three correct criteria. Note that while any individual meeting
these criteria may enroll in QHP coverage through the Marketplace
during the annual Open Enrollment period, QHPs are generally not
intended for individuals who are eligible for or enrolled in other
types of minimum essential coverage, such as employer-sponsored
coverage, Medicaid, CHIP, TRICARE (the Department of Defense heath
care program), and certain other types of coverage.
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Page: 3 of 6: Scenario 1: Question 2
Prompt Select the best answer and then click Check Your
Answer.
Question Shanika has another question. After her dad retires, he
and her mom (who is covered under his employer’s group health plan)
will no longer have health coverage. She is wondering whether her
parents are eligible for Marketplace coverage or
government-sponsored programs. What should you advise Shanika?
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Options
A. Her parents may both be eligible for Medicare since her dad
is age 65 and her mom is under age 65 with a disability. You point
out that the Marketplace does not determine eligibility for the
Medicare program.
B. Her parents should wait until several months after Malik's
retirement to get their finances in order, and then follow up with
you for assistance in seeking health coverage through the
Marketplace.
C. Her parents may be eligible to enroll in a Marketplace plan.
You tell Shanika that you can assist her parents with eligibility,
plan selection, and enrollment.
Correct Answer A
Positive Feedback You are right! Shanika’s parents may both be
eligible for Medicare and should explore that option first.
Consistent with the longstanding prohibition on the sale of
duplicate coverage to Medicare beneficiaries, it is illegal to sell
or issue a QHP to a Medicare beneficiary with the knowledge that
the QHP duplicates the beneficiary’s Medicare benefits. As an agent
or broker, you should protect yourself by asking each applicant
about his or her Medicare status and, for consumers who may be
eligible for Medicare, direct them to contact Medicare for
information on eligibility, the enrollment process, and enrollment
timeframes. Remember, since Shanika’s parents are losing health
coverage when her dad retires, they may have to pay the entire cost
of all medical care received.
http://www.medicare.gov/
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Page: 4 of 6: Scenario 1: Question 3
Prompt Select the best answer and then click Check Your
Answer.
Question Shanika brings her parents, Malik and Kayla, to see you
because they want health coverage for their younger child, Jada.
You assist them in completing the Marketplace application on behalf
of Jada, and they receive an eligibility determination that says
Jada may be eligible for Medicaid/CHIP. You tell Malik and Kayla
that Jada’s application will be transferred to the Florida
Medicaid/CHIP office, which will follow up with them to complete
Jada’s enrollment. However, they find this objectionable as they
are anxious to complete the process, and they ask you what they can
do to enroll Jada in health coverage today. What should you advise
them to do?
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Options
A. Tell them that they have no other options and should wait for
the Florida Medicaid/CHIP office to contact them to complete the
enrollment.
B. Tell them that they may enroll Jada in a QHP available
through the Marketplace, although it is likely not in their
financial best interests to do so.
C. Tell them that they should appeal the eligibility
determination because this may expedite the Florida Medicaid/CHIP
enrollment process.
Correct Answer B
Positive Feedback You are right! Since Jada may be eligible for
Medicaid/CHIP, it is likely not in her parents’ financial best
interests to enroll her in a Marketplace QHP because they will not
be eligible to receive either APTC or income-based CSRs and would
be required to pay the full premiums for her coverage. If Malik and
Kayla insist on this option and want to enroll Jada in a QHP, they
should submit a new application and indicate that they do not want
help paying for coverage. Remember, the appeals process is for
consumers who disagree with the eligibility determination, so it
would be inappropriate to file an appeal in this situation.
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Page: 5 of 6: Scenario 1: Question 4
Prompt Select the best answer and then click Check Your
Answer.
Question After you have finished your discussion with her
parents, Shanika starts to wonder if she can get a better deal on
her own health coverage if she disenrolls from her employer’s
health plan and seeks coverage through the Marketplace. She asks
for your advice on whether she can apply and get coverage through
the Marketplace. What should your answer be?
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Options
A. You are not eligible to enroll in a QHP through the
Marketplace since you are already receiving employer-sponsored
coverage.
B. Even though you are receiving employer-sponsored coverage,
you may purchase a QHP through the Marketplace as long as you meet
the eligibility criteria. However, you need to keep in mind that,
if you decide to go that route, you will not be eligible for
financial help, such as APTC and income-based CSRs, to help pay for
coverage through the Marketplace, so this option may not be in your
best financial interest.
C. You should definitely purchase a QHP through the Marketplace
since you will be eligible for APTC and income-based CSRs that will
make your monthly payments and out-of-pocket expenses more
affordable.
Correct Answer B
Positive Feedback You are right! Shanika may enroll in a QHP
through the Marketplace as long as she meets the eligibility
criteria. However, individuals who are enrolled in
employer-sponsored coverage, or are eligible for employer-sponsored
coverage that is affordable and meets the minimum value standard,
are NOT eligible for APTC and income-based CSRs.
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Page: 6 of 6: Scenario 1: Completion
Page Text In this scenario, you learned that: • To be eligible
to obtain health coverage through the Marketplace, an individual
must:
o Be a resident of the state where he or she will apply for
coverage and enroll in a QHP; o Be a U.S. citizen or national, or a
lawfully present non-citizen, and expect to remain so for the
entire period coverage
is sought; and o Not be incarcerated, other than incarceration
pending the disposition of charges.
• QHP coverage through the Marketplace is generally not intended
for individuals who are eligible for or enrolled in other types of
minimum essential coverage.
• A person who is eligible to receive Medicaid or CHIP, or who
is eligible for employer-sponsored coverage that is affordable and
meets the minimum value standard, may purchase QHP coverage through
the Marketplace, but is not eligible for financial help, such as
APTC and income-based CSRs, to help pay for QHP coverage.
You have completed Scenario 1. Return to the Menu and proceed to
Scenario 2. Alt Text A woman has her right arm extended out to her
side and her right hand is open faced directing your attention the
text on the left of the screen.
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16 This content is valid through July 2021.
Topic: 3 of 7: Scenario 2: Helping Consumers Resolve a Data
Matching Issue Page: 1 of 6: Scenario 2: Narrative
Page Text Mike Bradshaw is an agent in Charlotte, North
Carolina, who is meeting with a consumer, Maheen Sangha, to help
her complete a Marketplace application via HealthCare.gov. When
they view Maheen’s eligibility notice, it says Maheen is eligible
for a QHP through the Marketplace, the APTC, and income-based CSRs.
However, the notice also says “Send the Marketplace more
information” and indicates there is an issue in the data used to
establish Maheen’s immigration status. Alt Text A woman and a man
looking at a laptop screen
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Page: 2 of 6: Scenario 2: Question 1
Prompt Select the best answer and then click Check Your
Answer.
Question How will the notice of a Marketplace issue impact
Maheen’s eligibility to enroll in a QHP through the
Marketplace?
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Options
A. It means Maheen must provide an attestation indicating she is
eligible to enroll in a Marketplace QHP; this attestation will
resolve any data matching issues.
B. It means Maheen cannot enroll in a QHP through the
Marketplace; she must resolve her eligibility issue and then wait
until the next Open Enrollment period to obtain health coverage
through the Marketplace.
C. It means Maheen may enroll in a QHP and receive APTC and
income-based CSRs through the Marketplace, but she must take action
to resolve the issue between her Marketplace application and the
information contained in the approved electronic sources the
Marketplace uses to verify her eligibility.
Correct Answer C
Positive Feedback You are right! If there are issues between a
consumer’s application and the information contained in the
approved electronic sources, the Marketplace produces an initial
eligibility notice that includes a temporary 90-day eligibility
determination, and a list of any "data matching issues," along with
instructions for how they can be resolved. If the consumer does not
resolve the issue, he or she may lose eligibility for coverage
through the Marketplace or modification of APTC, if applicable. The
most common types of data matching issues are related to annual
household income, citizenship, and immigration status. (In the case
of a citizenship or immigration status issue, the length of the
resolution period is 95 days.) Remember, the consumer may attest to
having eligibility for health coverage, but that attestation is
only good for a 90-day/95-day period, during which the consumer
must provide satisfactory documentation to the Marketplace to
resolve the inconsistency; otherwise, he or she may lose
eligibility for health coverage through the Marketplace.
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Page: 3 of 6: Scenario 2: Question 2
Prompt Select all that apply and then click Check Your
Answer.
Question Mike reviews the eligibility results with Maheen and
explains to her that she may still enroll in a QHP through the
Marketplace with APTC and the income-based CSRs that she qualified
for, but that the Marketplace needs additional information
regarding her immigration status to resolve a data issue. What
advice should Mike share with Maheen for resolving the data
matching issue?
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Options
A. He should encourage Maheen to submit the requested
information as soon as possible, preferably by uploading the
requested documents through her HealthCare.gov account.
B. He should emphasize that if Maheen does not send the
requested documentation by the deadline, she may lose eligibility
for health coverage through the Marketplace.
C. He should direct Maheen to start over with a new Marketplace
application and answer the immigration status questions differently
to see if she gets a different eligibility determination
result.
Correct Answer A, B
Positive Feedback You are right! Agents and brokers can play an
important role in helping consumers understand and follow the
correct process to resolve data matching issues. Digital upload is
the fastest way to submit the requested information to the
Marketplace. For screen-by-screen uploading directions, see this
resource. Agents and brokers may be able to use the Enhanced Direct
Enrollment Pathway to upload their clients’ documents to resolve
data matching issues and to view of the status of those issues. To
find out more about specific Enhanced Direct Enrollment features,
contact the issuer or web-broker directly. Mike should make sure
Maheen understands the process and deadline for resolving the data
matching issue, and knows the consequences of not taking the
requested action.
https://www.healthcare.gov/downloads/how-to-submit-documents-to-confirm-application-information.pdfhttps://data.healthcare.gov/issuer-partner-lookup
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Page: 4 of 6: Scenario 2: Question 3 Narrative
Page Text Eight months later, Maheen calls Mike and is upset
because she has just received a Marketplace notice informing her
that she may be enrolled in a Marketplace plan with APTC or
income-based CSRs and enrolled in Medicaid in North Carolina. The
notice also indicates that she should act immediately to update her
Marketplace coverage because she is no longer eligible for APTC or
income-based CSRs if she does, in fact, have Medicaid coverage that
qualifies as minimum essential coverage.
Mike knows that this notice was generated by the Marketplace
data matching that it conducts periodically throughout the year to
identify consumers who are “dually enrolled” in both Marketplace
coverage with APTC and/or income-based CSRs and in Medicare,
Medicaid, or CHIP that qualifies as minimum essential
coverage.*
Mike explains the data matching process to Maheen and discovers
that, in Maheen’s case, she is receiving this notice because she
applied for Medicaid directly with the North Carolina state
Medicaid agency and was determined eligible, but she failed to
terminate her Marketplace coverage with APTC and income-based
CSRs.
*Note: Most Medicaid coverage is considered minimum essential
coverage. Some forms of Medicaid cover limited benefits (like
Medicaid that only covers emergency care, family planning, or
pregnancy-related services) and are not considered minimum
essential coverage. For more information on which Medicaid programs
are considered minimum essential coverage, visit HealthCare.gov.
Most CHIP coverage is also considered minimum essential coverage.
Medicare Part A and Medicare
https://www.healthcare.gov/medicaid-limited-benefits/
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Part C (otherwise known as Medicare Advantage) are considered
minimum essential coverage. Medicare Parts B or D alone are not
considered minimum essential coverage.
Alt Text Woman with her back to the camera looking at a
cellphone in her right hand
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Page: 5 of 6: Scenario 2: Question 3
Prompt Select the best answer and then click Check Your
Answer.
Question Since Maheen is enrolled in Medicaid, what should Mike
advise her to do in response to this notice?
Options
A. She should take no action in response to this notice.
B. She should immediately contact the applicable Marketplace to
end her Marketplace coverage with APTC.
C. She should contact the North Carolina state Medicaid agency
to end her Medicaid coverage and keep her Marketplace coverage with
APTC and income-based CSRs.
Correct Answer B
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24 This content is valid through July 2021.
Positive Feedback You are right! Consumers can end their
Marketplace coverage online by visiting HealthCare.gov or by
contacting the Marketplace Call Center at 1-800-318-2596 (TTY:
1-855-889-4325). If Maheen takes no action by the deadline
specified in the notice she received, the Marketplace will end any
APTC/CSRs being paid on her behalf, and her Marketplace coverage
will continue without financial help. You can review the following
resources for additional information regarding how consumers can
end a Marketplace plan in response to a notice resulting from
periodic data matching.
• More information about ending Marketplace coverage with
APTC/CSRs, and instructions on how to keep a Marketplace plan
without APTC and CSRs, are available at this link.
• More information about updating a Marketplace application and
reporting a change is available at this link.
Remember, because she is eligible for Medicaid, Maheen may
cancel her Medicaid enrollment and keep her QHP coverage through a
Marketplace, but she would not be eligible for APTC or income-based
CSRs to help her pay for that coverage. Consumers who do not think
they are enrolled in Medicaid or CHIP should contact their state
Medicaid or CHIP agency to confirm that they are not enrolled in or
eligible for Medicaid or CHIP, and update their Marketplace
application accordingly to tell the Marketplace they are not
enrolled in Medicaid or CHIP.
https://www.healthcare.gov/how-to-cancel-a-marketplace-plan/http://www.healthcare.gov/medicaid-chip/cancelling-marketplace-plan/
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Page: 6 of 6: Scenario 2: Completion
Page Text In this scenario, you learned that: • Agents and
brokers can play an important role in helping consumers understand
and take the required steps to resolve
issues identified through the Marketplace data matching process.
• Consumers who are dually enrolled in both Marketplace coverage
with APTC and/or income-based CSRs and in Medicaid
or CHIP that qualifies as minimum essential coverage must either
end their Marketplace coverage or update their Marketplace
application to tell the Marketplace that they are not enrolled in
Medicaid or CHIP by the deadline on the notice they receive;
otherwise, the Marketplace will end any APTC/CSRs being paid on
their behalf, and their Marketplace coverage will continue without
financial help.
You have completed Scenario 2. Return to the Menu and proceed to
Scenario 3. Alt Text Image of the back side of a computer with
several yellow Ethernet cables plugged into it
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26 This content is valid through July 2021.
Topic: 4 of 7: Scenario 3: Eligibility for Financial Assistance
through the Marketplace Page: 1 of 5: Scenario 3: Narrative
Page Text Eligibility for Financial Assistance through the
Marketplace You are meeting with Roger and James Hansen, a married
couple with no dependents, who are interested in exploring their
eligibility for financial assistance if they choose to enroll in a
QHP through the Marketplace. Roger and James are both U.S. citizens
and meet the other eligibility criteria for enrollment in a QHP,
and they use the “Married Filing Jointly” filing status on their
federal income tax return. Alt Text A woman and two men are meeting
and sitting around a table in an office.
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Page: 2 of 5: Scenario 3: Question 1
Prompt Select the best answer and then click Check Your
Answer.
Question What other eligibility criteria must Roger and James
meet to qualify for APTC?
Options
A. Either Roger or James must be eligible to enroll in other
minimum essential coverage, such as employer-sponsored coverage or
a government-sponsored program.
B. They must have been enrolled in a Marketplace QHP for the
previous plan year; otherwise, they may claim the tax credit on
their federal income tax return, but they may not qualify to
receive the premium tax credit in advance.
C. They must have an annual household income between 100% and
400% of the federal poverty level (FPL).
Correct Answer C
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Positive Feedback You are right! Eligibility for APTC is based
on projected annual household income, projected family size, and
other eligibility criteria for the coverage year. Remember, a
person eligible to enroll in employer-sponsored coverage that meets
affordability and minimum value standards or a government-sponsored
program that meets the minimum essential coverage requirements is
not eligible for APTC. In addition, if a consumer qualifies for the
premium tax credit based on his or her income estimate, that
consumer is eligible for APTC to lower the monthly premium payment,
regardless of his or her history of Marketplace participation.
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Page: 3 of 5: Scenario 3: Question 2
Prompt Select the best answer and then click Check Your
Answer.
Question The Hansens have an annual household income of
approximately $38,000, which puts them at about 225% of the FPL.
After you assist them with completing the Marketplace application,
their Marketplace eligibility determination confirms they are
eligible to enroll in a QHP with APTC. In addition, the
determination notes that their income qualifies them for CSRs,
which may save them money on out-of-pocket-costs like deductibles,
copayments, and coinsurance. When you start reviewing their QHP
options with them, Roger and James ask you what they need to do to
ensure they get the CSRs for which they qualify. What should you
advise Roger and James?
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Options
A. They should enroll in a Bronze plan through the
Marketplace.
B. They should enroll in a Silver plan through the
Marketplace.
C. They should enroll in a catastrophic plan through the
Marketplace.
Correct Answer B
Positive Feedback You are right! Consumers who qualify for
income-based CSRs can only get these savings if they enroll in a
plan in the Silver plan category. (Note: Consumers who are members
of federally recognized tribes or shareholders in Alaska Native
Claims Settlement Act [ANCSA] Corporations may receive CSRs if they
enroll in a plan in any plan category, except for catastrophic
plans.) Remember, while a Silver plan may have a monthly premium
that is higher than a Bronze plan’s premium, the Hansens may spend
less on health care overall if they enroll in a Silver plan so they
can apply the CSRs to their health care expenses.
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Page: 4 of 5: Scenario 3: Question 3
Prompt Select all that apply and then click Check Your
Answer.
Question Before you end your meeting with the Hansens, you
encourage them to report changes in their income to the Marketplace
throughout the year as they happen so that the Marketplace can
adjust their APTC, if needed. You also explain to them that they
will have to use their actual household income to reconcile the
allowed premium tax credit with the APTC paid on their behalf for
their QHP premiums when they file their federal tax return for the
applicable plan year. Which of the following scenarios could apply
for the APTC reconciliation process?
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Options
A. If the amount of the allowed premium tax credit is more than
the amount the Hansens chose to have paid directly to the issuer,
or received as APTC (i.e., a net premium tax credit), the
difference (called "net premium tax credit") will increase the
Hansens’ refund or reduce their tax liability.
B. If the amount of the allowed premium tax credit is less than
the APTC, excess APTC was paid on the Hansens’ behalf. The Hansens
must enter the APTC amount on their return and will be required to
repay all or a portion of it when filing the tax return. The excess
APTC repayment amount may be limited for tax filers with actual
annual household income below 400% of the FPL for the tax filer’s
family size..
C. If the Hansens do not file a federal tax return for the year
in which APTC were paid on their behalf, the Marketplace will
discontinue their future eligibility for APTC and CSRs to help pay
for their Marketplace health insurance coverage.
Correct Answer A, B, and C
Positive Feedback You are right! Any of these scenarios may
apply. As an agent or broker, you are prohibited from helping
consumers with filing their taxes unless you are also a licensed
tax professional. However, you may play an important role in
helping consumers make the connection between reconciling APTC paid
on their behalf when they file federal income taxes. You should
also encourage consumers to promptly report changes in
circumstances to the Marketplace as they happen to allow the
Marketplace to update the information used to determine eligibility
for APTC and to adjust the APTC amount. This adjustment decreases
the likelihood of a significant difference between the tax filer’s
APTC and his or her allowed premium tax credit. Changes in
circumstances that can affect the amount of the actual premium tax
credit include: increases or decreases in household income,
marriage, divorce, birth or adoption of a child, other changes in
household composition, gaining or losing eligibility for a
government-sponsored program or employer-sponsored health care
coverage, and change of address.
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Page: 5 of 5: Scenario 3: Completion
Page Text In this scenario, you learned that: • Consumers who
meet specified criteria for projected annual household income,
projected family size, and other eligibility
criteria for the coverage year may qualify for financial
assistance to help them afford health coverage purchased through
the Marketplace. This assistance may include APTC to lower their
monthly premium payments and income-based CSRs that reduce their
out-of-pocket expenses.
• Consumers who choose to apply some or all of the premium tax
credit towards QHP premium costs on an advance basis must reconcile
the allowed premium tax credit with the advance payments made on
their behalf when they file their federal tax returns for the
applicable plan year.
You have completed Scenario 3. Return to the Menu and proceed to
Scenario 4. Alt Text Image of a person's hand holding an IRS 1040
tax form
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Topic: 5 of 7: Scenario 4: Open Enrollment Period and Special
Enrollment Periods Page: 1 of 4: Scenario 4: Narrative
Page Text Magda Lorence, a 32-year-old female, lives in
Missouri, and is exploring her options to finding health coverage
for herself. She sent you an email last night asking when the next
Marketplace Open Enrollment period is. She is wondering if the
enrollment period starts and ends at the same time every year. You
are going through your emails this morning and are now getting
ready to reply to Magda’s question. Alt Text A woman sitting at a
desk with a laptop in front of her and looking at an index card
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Page: 2 of 4: Scenario 4: Question 1
Prompt Select the best answer and then click Check Your
Answer.
Question You inform Magda she may apply for an eligibility
determination and enroll in a Marketplace QHP during the annual
Open Enrollment period for plan year 2021, which is:
Options
A. October 1, 2020 through January 31, 2021
B. November 1, 2020 through December 15, 2020
C. November 15, 2020 through February 15, 2021
D. November 1, 2020 through January 31, 2021
Correct Answer B
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36 This content is valid through July 2021.
Positive Feedback You are right! The Marketplace Open Enrollment
period for plan year 2021 is between November 1, 2020 and December
15, 2020. Consumers must complete their plan selections by December
15 for their health coverage to become effective on January 1.
There are no opportunities to make an Open Enrollment plan
selection after December 15. Remember that special enrollment
periods (SEPs) may be approved throughout the year, based on
consumers’ special circumstances. Marketplace enrollees who qualify
for an SEP and want to change plans may need to select a new plan
within the same plan category as their current plan, or wait until
the next Open Enrollment period to change to a plan in a different
category. Plan category limitations may apply when consumers:
• Currently have a Marketplace plan, • Experience certain
SEP-qualifying events, and • Want to change from their current
plan.
Most common SEP types, like a loss of qualifying coverage,
permanent change in primary place of living, or gaining or becoming
a dependent through birth, adoption, foster care, or court order,
are subject to plan category limitations. Also, keep in mind that
the Small Business Health Options Program (SHOP) is open all year
and you may assist employers with the SHOP application and
enrollment process during any month of the year.
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Page: 3 of 4: Scenario 4: Question 2
Prompt Select the best answer and then click Check Your
Answer.
Question You helped Magda enroll in a Marketplace QHP that
became effective on January 1. Magda gets married in September, so
she qualifies for a 60-day Marriage SEP. At that time, will she and
her new spouse need to submit documents to the Marketplace to
confirm their eligibility for the Marriage SEP?
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38 This content is valid through July 2021.
Options
A. Yes. Magda and her new spouse will need to submit
documentation to the Marketplace proving their marriage (such as a
marriage license or certificate showing the date of the
marriage).
B. No. Because Magda is are already enrolled in Marketplace
coverage, she is not subject to the SEP pre-enrollment verification
process.
C. Maybe. It depends on whether they want to switch plans or add
one spouse to the other’s current QHP.
Correct Answer B
Positive Feedback You are right! Existing Marketplace enrollees
who attest to SEP qualifying events are not subject to the SEPV
process. New applicants (i.e., those who are not already enrolled
in Marketplace coverage) who attest to certain types of SEP
qualifying events are subject to SEPV. Eligible consumers must
submit documents that confirm their SEP eligibility before the
Marketplace finalizes their enrollment and they can make their
first payment and start using their Marketplace coverage.
Pre-enrollment verification has been implemented in connection with
five SEP types:
• Loss of minimum essential coverage • Permanent move • Marriage
• Gaining or becoming a dependent through adoption, placement for
adoption, placement in foster care, or a child support or
other court order • Medicaid/CHIP coverage denial
You should help consumers understand what may make them eligible
for an SEP and what they need to submit in terms of documentation
to prove eligibility for an SEP. For more information, check out
the following resources:
• “Special Enrollment Periods: An Overview for Marketplace
Agents and Brokers” webinar slides • "Special Enrollment Period
Pre-Enrollment Verification (SEPV): Review” webinar slides • How to
Submit Documents
https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/AB-SEP-Slides-Feb152018.pdfhttps://marketplace.cms.gov/technical-assistance-resources/sepv-review.pdfhttps://www.healthcare.gov/tips-and-troubleshooting/uploading-documents/
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Page: 4 of 4: Scenario 4: Completion
Page Text In this scenario, you learned that: • The annual Open
Enrollment period for plan year 2021 is between November 1, 2020
and December 15, 2020.
Consumers must complete their plan selections by December 15 for
their health coverage to become effective on January 1. There are
no opportunities to make an Open Enrollment plan selection after
December 15.
• SEPs are based on certain triggering events, which include
gaining or becoming a dependent, loss of minimum essential
coverage, or other exceptional circumstances.
• Most common SEP types, like a loss of qualifying coverage,
permanent change in primary place of living, or gaining or becoming
a dependent through birth, adoption, foster care, or court order,
are subject to plan category limitations. This means if a current
Marketplace enrollee wants to change plans during an SEP that he or
she qualifies for, the consumer may need to select a new plan
within the same plan category as his or her current plan, and wait
until the next Open Enrollment if the consumer wants to change to a
plan in a different category.
• The Marketplace uses a pre-enrollment verification process for
new applicants (those who are not already enrolled in Marketplace
coverage) to confirm their eligibility for the type of SEP they
requested.
You have completed Scenario 4. Return to the Menu and proceed to
Scenario 5. Alt Text An image of a calendar with days and dates
showing in a table
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Topic: 6 of 7: Scenario 5: Enrollment Pathways and Recording
Your NPN on Applications Page: 1 of 6: Scenario 5: Narrative
Page Text
Enrollment Pathways and Recording Your NPN on Applications
Drew Chantel is meeting with an agent, Grace Rodriquez, whom he
found using the “Find Local Help” tool available at HealthCare.gov,
to obtain an eligibility determination and enroll in a QHP through
the Marketplace. Consumers may use one of three pathways to
complete the Marketplace application:
• The Marketplace Pathway (via HealthCare.gov) • The Classic
Direct Enrollment Pathway • The Enhanced Direct Enrollment
Pathway
Grace explains to Drew that all enrollment pathways use a
dynamic, “smart” process that is based on the consumer’s
circumstances, and generally only ask questions that are relevant
to that consumer.
Alt Text A woman and a man sitting next to each other with the
man looking at a day planner that the woman is holding
https://localhelp.healthcare.gov/https://www.healthcare.gov/
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Page: 2 of 6: Scenario 5: Question 1
Prompt Select the best answer and then click Check Your
Answer.
Question Which of the following is a feature of using the
Classic Direct Enrollment Pathway?
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Options
A. Registered agents and brokers affiliated with approved QHP
issuers or web-brokers can log on to the issuer's or web-broker's
(referred to as "partners") agent/broker portal, be redirected to
an agent/broker landing page at HealthCare.gov, and enter
information in the Marketplace application on behalf of the
consumer.
B. An agent or broker has to sit "side-by-side" with the
consumer to provide assistance; the consumer creates an account at
HealthCare.gov, logs in to the site with a consumer account, and
"drives" the process.
C. An agent or broker can only make changes to a consumer's
application by conducting a three-way call with the consumer and
the Marketplace Call Center.
Correct Answer A
Positive Feedback You are right! When using the Direct
Enrollment Pathway, you can enter application information without
having to sit side-by-side with the consumers you are helping. As
part of the Direct Enrollment Pathway, you can also modify a
consumer’s account after a plan selection has already been made
(e.g., report a change in income or add a newborn under an SEP)
without having to contact the Marketplace Call Center. You should
contact your Classic Direct Enrollment provider to determine
whether it supports changes to a consumer’s application outside of
the Open Enrollment period, because not all do.
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Page: 3 of 6: Scenario 5: Question 2
Prompt Select all that apply and then click Check Your
Answer.
Question Which of the following is a feature of using the
Enhanced Direct Enrollment Pathway?
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Options
A. Registered agents and brokers affiliated with approved QHP
issuers or web-brokers can log on to the issuer's or web-broker's
agent/broker portal and have the ability to assist individuals in
applying for and enrolling in Marketplace coverage directly from
the QHP issuer’s or web-broker’s website without the redirect to
and from the HealthCare.gov website.
B. Enhanced Direct Enrollment websites include payment
functionality that allows the qualified individual to make the
initial premium payment directly, or that allows the qualified
individual to redirect to the applicable issuer.
C. An agent or broker may be able to view and download their
clients’ Marketplace notices and assist their clients with
year-round Marketplace functions.
Correct Answer A, B, C
Positive Feedback You are right! Approved partners offering the
Enhanced Direct Enrollment Pathway may provide the full one-site
experience for application, enrollment, and post-enrollment support
on their own websites, without the redirect to and from the
HealthCare.gov website. They may customize the Marketplace
application, as long as they do not alter the substance of the
Marketplace application, potentially simplifying and streamlining
the questions that consumers are asked. Enhanced Direct Enrollment
websites offer functionality to that allows the qualified
individual to make the initial premium payment directly or
redirects the qualified individual to the applicable issuer’s
payment website for the initial premium payment. Enhanced Direct
Enrollment Partners may also offer a range of client management
functions for you to more easily assist consumers year-round. These
capabilities may vary, but will generally include the ability to
upload documents to adjudicate data matching issues and SEP
verification issues, view the status of those issues, and download
Marketplace notices, such as the Eligibility Determination Notice
and Form 1095-A. You may find a QHP issuer or web-broker who is
approved by the Centers for Medicare & Medicaid Services to
offer the Enhanced Direct Enrollment Pathway via the Issuer and
Direct Enrollment Partner Directory.
https://data.healthcare.gov/issuer-partner-lookuphttps://data.healthcare.gov/issuer-partner-lookup
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Page: 4 of 6: Scenario 5: Question 3
Prompt Select the best answer and then click Check Your
Answer.
Question Drew elects to use the Marketplace Pathway at
HealthCare.gov, and has created his own Marketplace user account
and is working with Grace at her office to complete the eligibility
questions. Drew encounters a screen with the heading “Application
Help" and the question "Is a professional helping you complete your
application?” What should Grace direct Drew to select on his
screen?
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Options
A. Grace should ensure Drew selects the box for "Agent or
Broker." This will produce a new set of fields, including one
labeled “National Producer Number,” which is where Drew should
enter Grace's name and NPN to record her assistance with his
Marketplace application.
B. Grace should ask Drew to indicate, in any of the comment
boxes he can type in, that he is getting help by including her name
and state license number.
C. Grace should inform Drew that he does not need to make any
entries on that screen.
Correct Answer A
Positive Feedback You are right! Grace should ensure Drew enters
her name and NPN in the appropriate fields on this screen to
indicate that she assisted him with this application. Both Grace's
NPN and name are required to record her assistance on the
Marketplace enrollment transaction. Remember, agents and brokers
should ensure their clients enter this information correctly. A
state license number is not a valid entry. For more information on
recording your NPN on Marketplace applications, review this
resource.
https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Instruct-Consumers-NPN-Marketplace.pdf
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Page: 5 of 6: Scenario 5: Question 4
Prompt Select all that apply and then click Check Your
Answer.
Question Drew changes jobs in the middle of the plan year and
recalls that Grace told him he should report any changes to his
income so that the Marketplace can adjust his APTC, if needed.
Which of the following methods can Drew use to report the change
while ensuring Grace’s NPN remains associated with his
application?
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48 This content is valid through July 2021.
Options
A. He can log in to his Marketplace account, select the
application, and then select “Report a life change” from the menu
on the left.
B. He can contact the Marketplace Call Center at 1-800-318-2596
(TTY: 1-855-889-4325).
C. He can ask Grace to conduct a three-way call between Grace,
Drew, and the Marketplace Call Center.
D. He can ask Grace to log in to his Marketplace account to
report his modified income.
Correct Answer A, B, C
Positive Feedback You are right! Grace’s NPN will remain
associated with Drew’s application using any of these reporting
methods, unless Drew actively removes or changes it, or requests
that the Marketplace Call Center representative change the agent or
broker of record on the application. Marketplace Call Center
representatives will not remove an agent’s or broker’s NPN from an
application unless requested by the consumer. Remember, consumers
or their legally authorized representatives should not share their
Marketplace usernames or passwords with third parties, including
agents and brokers. Grace may not log in to HealthCare.gov as Drew
to report his income change to the Marketplace.
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Page: 6 of 6: Scenario 5: Completion
Page Text In this scenario, you learned that: • Agents and
brokers who use the Classic or Enhanced Direct Enrollment Pathway
can enter application information without
having to sit side-by-side with the consumers they are helping.
• Approved partners offering the Enhanced Direct Enrollment Pathway
may provide the full one-site experience for
application, enrollment, and post-enrollment support on their
own websites. This may include payment functionality that allows
the qualified individual to make the initial premium payment
directly or a link to a separate website for the qualified
individual to make the initial premium payment, and client
management functions that enable agents and brokers to more easily
assist consumers year-round.
• Agents and brokers should ensure each application with which
they assist includes their name and NPN to indicate that they
assisted the consumer.
• Once an agent’s or broker’s NPN is recorded on an application,
it stays with the application unless the consumer actively removes
or changes it, or requests that the Marketplace Call Center
Representative change the agent or broker of record on the
application.
You have completed Scenario 5. Return to the Menu and proceed to
the Key Points for this Review. Alt Text Image of a man and woman
sitting at a desk; The woman is typing on a laptop and turns around
to face the camera.
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50 This content is valid through July 2021.
Topic: 7 of 7: Key Points Page: 1 of 2: Module Summary
Long Description Interactive graphic: A collage of icons
representing module-specific concepts is displayed; three
equally-sized rectangular buttons are shown from left to right
across the bottom of the page. Each rectangular button has a label
that corresponds to a key module topic or concept. When each button
is selected, a pop-up box appears and displays accompanying text.
Prompt text: Select each button and review the key points of this
lesson. Eligibility
• To be eligible to obtain health insurance through the
Marketplace, an individual must be a resident of the state where he
or she will apply for coverage and enroll in a QHP; be a U.S.
citizen or national, or a lawfully present non-citizen, and expect
to remain so for the entire period coverage is sought; and not be
incarcerated, other than incarceration pending the disposition of
charges.
• QHP coverage through the Marketplace is generally not intended
for individuals who are eligible for or enrolled in other types of
minimum essential coverage.
• Consumers who meet specified criteria for projected annual
household income, projected family size, and other eligibility
criteria for the coverage year may qualify for financial assistance
to help them afford health coverage purchased through the
Marketplace. This assistance may include APTC to lower their
monthly premium payments and income-based CSRs that reduce their
out-of-pocket expenses.
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51 This content is valid through July 2021.
• A person who is eligible to receive Medicaid or CHIP, or who
is eligible for employer-sponsored coverage that is affordable and
meets the minimum value standard, may purchase QHP coverage through
a Marketplace, but is not eligible for financial help, such as APTC
and income-based CSRs, to help pay for QHP coverage.
• Consumers who choose to apply some or all of the premium tax
credit towards QHP premium costs on an advance basis must reconcile
the allowed premium tax credit with the advance payments made on
their behalf when they file their federal tax returns for the
applicable plan year.
Data Matching Issues
• Consumers who are dually enrolled in both Marketplace coverage
with APTC and/or income-based CSRs and in Medicaid or CHIP that
qualifies as minimum essential coverage must either end their
Marketplace coverage or update their Marketplace application to
tell the Marketplace that they are not enrolled in Medicaid or CHIP
by the deadline on the notice they receive; otherwise the
Marketplace will end any APTC/CSRs being paid on their behalf, and
their Marketplace coverage will continue without financial
help.
• Agents and brokers can play an important role in helping
consumers understand and take the required steps to resolve issues
identified through the Marketplace data matching processes.
Enrollment
• The annual Open Enrollment period for plan year 2021 is
between November 1, 2020 and December 15, 2020. Consumers must
complete their plan selections by December 15 for their health
coverage to become effective on January 1. There are no
opportunities to make an Open Enrollment plan selection after
December 15.
• Agents and brokers who use the Classic or Enhanced Direct
Enrollment Pathway can enter application information without having
to sit side-by-side with the consumers they are helping.
• Approved partners offering the Enhanced Direct Enrollment
Pathway may provide the full one-site experience for application,
enrollment, and post-enrollment support on their own websites. This
may include payment functionality that allows the qualified
individual to make the initial premium payment directly or a link
to a separate website for the consumer to make the initial premium
payment, and client management functions that enable agents and
brokers to more easily assist consumers year-round.
• Agents and brokers should ensure each application with which
they assist contains their name and NPN to indicate that they
assisted the consumer.
• Once an agent’s or broker’s NPN is recorded on an application,
it stays with the application unless the consumer actively removes
or changes it, or requests that the Marketplace Call Center
Representative change the agent or broker of record on the
application.
SEPs
• SEPs are based on certain triggering events, which include
gaining or becoming a dependent, loss of minimum essential
coverage, or other exceptional circumstances.
• Most common SEP types, like a loss of qualifying coverage,
permanent change in primary place of living, or gaining or becoming
a dependent through birth, adoption, foster care, or court order,
are subject to plan category limitations. This means if a current
Marketplace enrollee wants to change plans during an SEP that he or
she qualifies for, the consumer may need to select a new plan
within the same plan category as his or her current plan, and wait
until the next Open Enrollment if the consumer wants to change to a
plan in a different category.
• The Marketplace uses a pre-enrollment verification process for
new applicants (those who are not already enrolled in Marketplace
coverage) to confirm their eligibility for the type of SEP they
requested.
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52 This content is valid through July 2021.
Page: 2 of 2: Module Completion
Page Text Congratulations! You have completed the Individual
Marketplace Review for Returning Agents and Brokers. Alt Text A
person standing on top of a mountain peak with arms
outstretched
Topic: 1 of 7: Welcome to the Individual Marketplace Review for
Returning Agents and BrokersPage: 1 of 4: Welcome to the Individual
Marketplace Review for Returning Agents and BrokersLong
Description
Page: 2 of 4: DisclaimerPage TextAlt Text
Page: 3 of 4: IntroductionPage TextAlt Text
Page: 4 of 4: Structure and NavigationPage TextAlt Text
Topic: 2 of 7: Scenario 1: Eligibility Criteria for Enrolling in
a QHPPage: 1 of 6: Scenario 1: NarrativePage TextAlt Text
Page: 2 of 6: Scenario 1: Question 1PromptQuestionA. There are
three criteria individuals must meet: (1) Be residents of the state
where they will apply for coverage and enroll in a QHP; (2) Be U.S.
citizens or nationals, or lawfully present non-citizens, and expect
to remain so for the entire period...B. There are three criteria
individuals must meet: (1) Be residents of the state where they
will apply for coverage and enroll in a QHP; (2) Be U.S. citizens
or nationals, or lawfully present non-citizens, and expect to
remain so for the entire period...C. There are three criteria
individuals must meet: (1) Be residents of the state where they
will apply for coverage and enroll in a QHP; (2) Be employed for at
least one year in the state where they will apply for coverage and
enroll in a QHP; and (3)...Correct AnswerPositive Feedback
Page: 3 of 6: Scenario 1: Question 2PromptQuestionOptionsA. Her
parents may both be eligible for Medicare since her dad is age 65
and her mom is under age 65 with a disability. You point out that
the Marketplace does not determine eligibility for the Medicare
program.B. Her parents should wait until several months after
Malik's retirement to get their finances in order, and then follow
up with you for assistance in seeking health coverage through the
Marketplace.C. Her parents may be eligible to enroll in a
Marketplace plan. You tell Shanika that you can assist her parents
with eligibility, plan selection, and enrollment.Correct
AnswerPositive Feedback
Page: 4 of 6: Scenario 1: Question 3PromptQuestionOptionsA. Tell
them that they have no other options and should wait for the
Florida Medicaid/CHIP office to contact them to complete the
enrollment.B. Tell them that they may enroll Jada in a QHP
available through the Marketplace, although it is likely not in
their financial best interests to do so.C. Tell them that they
should appeal the eligibility determination because this may
expedite the Florida Medicaid/CHIP enrollment process.Correct
AnswerPositive Feedback
Page: 5 of 6: Scenario 1: Question 4PromptQuestionOptionsA. You
are not eligible to enroll in a QHP through the Marketplace since
you are already receiving employer-sponsored coverage.B. Even
though you are receiving employer-sponsored coverage, you may
purchase a QHP through the Marketplace as long as you meet the
eligibility criteria. However, you need to keep in mind that, if
you decide to go that route, you will not be eligible...C. You
should definitely purchase a QHP through the Marketplace since you
will be eligible for APTC and income-based CSRs that will make your
monthly payments and out-of-pocket expenses more affordable.Correct
AnswerPositive Feedback
Page: 6 of 6: Scenario 1: CompletionPage TextAlt Text
Topic: 3 of 7: Scenario 2: Helping Consumers Resolve a Data
Matching IssuePage: 1 of 6: Scenario 2: NarrativePage TextAlt
Text
Page: 2 of 6: Scenario 2: Question 1PromptQuestionOptionsA. It
means Maheen must provide an attestation indicating she is eligible
to enroll in a Marketplace QHP; this attestation will resolve any
data matching issues.B. It means Maheen cannot enroll in a QHP
through the Marketplace; she must resolve her eligibility issue and
then wait until the next Open Enrollment period to obtain health
coverage through the Marketplace.C. It means Maheen may enroll in a
QHP and receive APTC and income-based CSRs through the Marketplace,
but she must take action to resolve the issue between her
Marketplace application and the information contained in the
approved electronic sources t...Correct AnswerPositive Feedback
Page: 3 of 6: Scenario 2: Question 2PromptQuestionOptionsA. He
should encourage Maheen to submit the requested information as soon
as possible, preferably by uploading the requested documents
through her HealthCare.gov account.B. He should emphasize that if
Maheen does not send the requested documentation by the deadline,
she may lose eligibility for health coverage through the
Marketplace.C. He should direct Maheen to start over with a new
Marketplace application and answer the immigration status questions
differently to see if she gets a different eligibility
determination result.Correct AnswerPositive Feedback
Page: 4 of 6: Scenario 2: Question 3 NarrativePage TextAlt
Text
Page: 5 of 6: Scenario 2: Question 3PromptQuestionOptionsA. She
should take no action in response to this notice.B. She should
immediately contact the applicable Marketplace to end her
Marketplace coverage with APTC.C. She should contact the North
Carolina state Medicaid agency to end her Medicaid coverage and
keep her Marketplace coverage with APTC and income-based
CSRs.Correct AnswerPositive Feedback
Page: 6 of 6: Scenario 2: CompletionPage TextAlt Text
Topic: 4 of 7: Scenario 3: Eligibility for Financial Assistance
through the MarketplacePage: 1 of 5: Scenario 3: NarrativePage
TextAlt Text
Page: 2 of 5: Scenario 3: Question 1PromptQuestionOptionsA.
Either Roger or James must be eligible to enroll in other minimum
essential coverage, such as employer-sponsored coverage or a
government-sponsored program.B. They must have been enrolled in a
Marketplace QHP for the previous plan year; otherwise, they may
claim the tax credit on their federal income tax return, but they
may not qualify to receive the premium tax credit in advance.C.
They must have an annual household income between 100% and 400% of
the federal poverty level (FPL).Correct AnswerPositive Feedback
Page: 3 of 5: Scenario 3: Question 2PromptQuestionOptionsA. They
should enroll in a Bronze plan through the Marketplace.B. They
should enroll in a Silver plan through the Marketplace.C. They
should enroll in a catastrophic plan through the
Marketplace.Correct AnswerPositive FeedbackPromptQuestionOptionsA.
If the amount of the allowed premium tax credit is more than the
amount the Hansens chose to have paid directly to the issuer, or
received as APTC (i.e., a net premium tax credit), the difference
(called "net premium tax credit") will increase the ...B. If the
amount of the allowed premium tax credit is less than the APTC,
excess APTC was paid on the Hansens’ behalf. The Hansens must enter
the APTC amount on their return and will be required to repay all
or a portion of it when filing the tax retu...C. If the Hansens do
not file a federal tax return for the year in which APTC were paid
on their behalf, the Marketplace will discontinue their future
eligibility for APTC and CSRs to help pay for their Marketplace
health insurance coverage.Correct AnswerPositive Feedback
Page: 5 of 5: Scenario 3: CompletionPage TextAlt Text
Topic: 5 of 7: Scenario 4: Open Enrollment Period and Special
Enrollment PeriodsPage: 1 of 4: Scenario 4: NarrativePage TextAlt
Text
Page: 2 of 4: Scenario 4: Question 1PromptQuestionOptionsA.
October 1, 2020 through January 31, 2021B. November 1, 2020 through
December 15, 2020C. November 15, 2020 through February 15, 2021D.
November 1, 2020 through January 31, 2021Correct AnswerPositive
Feedback
Page: 3 of 4: Scenario 4: Question 2PromptQuestionOptionsA. Yes.
Magda and her new spouse will need to submit documentation to the
Marketplace proving their marriage (such as a marriage license or
certificate showing the date of the marriage).B. No. Because Magda
is are already enrolled in Marketplace coverage, she is not subject
to the SEP pre-enrollment verification process.C. Maybe. It depends
on whether they want to switch plans or add one spouse to the
other’s current QHP.Correct AnswerPositive Feedback
Page: 4 of 4: Scenario 4: CompletionPage TextAlt Text
Topic: 6 of 7: Scenario 5: Enrollment Pathways and Recording
Your NPN on ApplicationsPage: 1 of 6: Scenario 5: NarrativeAlt
Text
Page: 2 of 6: Scenario 5: Question 1PromptQuestionOptionsA.
Registered agents and brokers affiliated with approved QHP issuers
or web-brokers can log on to the issuer's or web-broker's (referred
to as "partners") agent/broker portal, be redirected to an
agent/broker landing page at HealthCare.gov, and enter...B. An
agent or broker has to sit "side-by-side" with the consumer to
provide assistance; the consumer creates an account at
HealthCare.gov, logs in to the site with a consumer account, and
"drives" the process.C. An agent or broker can only make changes to
a consumer's application by conducting a three-way call with the
consumer and the Marketplace Call Center.Correct AnswerPositive
Feedback
Page: 3 of 6: Scenario 5: Question 2PromptQuestionOptionsA.
Registered agents and brokers affiliated with approved QHP issuers
or web-brokers can log on to the issuer's or web-broker's
agent/broker portal and have the ability to assist individuals in
applying for and enrolling in Marketplace coverage direct...B.
Enhanced Direct Enrollment websites include payment functionality
that allows the qualified individual to make the initial premium
payment directly, or that allows the qualified individual to
redirect to the applicable issuer.C. An agent or broker may be able
to view and download their clients’ Marketplace notices and assist
their clients with year-round Marketplace functions.Correct
AnswerPositive Feedback
Page: 4 of 6: Scenario 5: Question 3PromptQuestionOptionsA.
Grace should ensure Drew selects the box for "Agent or Broker."
This will produce a new set of fields, including one labeled
“National Producer Number,” which is where Drew should enter
Grace's name and NPN to record her assistance with his Marketp...B.
Grace should ask Drew to indicate, in any of the comment boxes he
can type in, that he is getting help by including her name and
state license number.C. Grace should inform Drew that he does not
need to make any entries on that screen.Correct AnswerPositive
Feedback
Page: 5 of 6: Scenario 5: Question 4PromptQuestionOptionsA. He
can log in to his Marketplace account, select the application, and
then select “Report a life change” from the menu on the left.B. He
can contact the Marketplace Call Center at 1-800-318-2596 (TTY:
1-855-889-4325).C. He can ask Grace to conduct a three-way call
between Grace, Drew, and the Marketplace Call Center.D. He can ask
Grace to log in to his Marketplace account to report his modified
income.Correct AnswerPositive Feedback
Page: 6 of 6: Scenario 5: CompletionPage TextAlt Text
Topic: 7 of 7: Key PointsPage: 1 of 2: Module SummaryLong
Description
Page: 2 of 2: Module CompletionPage TextAlt Text