Covered California Certified Enrollment Counselor (CEC) Certification Exam — Questions and Answers

Question 1: Which of the following is NOT a type of health plan available through the ACA Marketplace?

HMO
Indemnity Plan (Correct answer)
EPO
PPO

Correct answer: Indemnity Plan

Traditional indemnity (fee-for-service) plans are generally not offered through the ACA Marketplace; plans are typically HMO, PPO, EPO, or POS.

Question 2: Which metal tier plan typically has the lowest monthly premium but highest out-of-pocket costs when care is used?

Silver
Gold
Platinum
Bronze (Correct answer)

Correct answer: Bronze

Bronze plans have the lowest premiums but highest cost-sharing (deductibles, copays, coinsurance), covering about 60% of average medical costs.

Question 3: After a beneficiary enrolls in a new Medicare Advantage plan, when does the new coverage typically begin?

At the start of the next calendar year regardless of enrollment date
60 days after the enrollment application is approved
Immediately upon submission of the enrollment application
The first day of the month following the month of enrollment, if all conditions are met (Correct answer)

Correct answer: The first day of the month following the month of enrollment, if all conditions are met

Medicare Advantage enrollment generally becomes effective the first day of the month following the month of enrollment, assuming the beneficiary has Medicare Parts A and B.

Question 4: A client enrolled in a PDP (Prescription Drug Plan) notices their medication is no longer covered after the plan's Annual Notice of Change. What is the best next step?

Continue using the plan and request an exception after the new year begins
Request the drug be added to the formulary during the current plan year
File a formal grievance with CMS immediately
Review the Annual Notice of Change and use the AEP to switch to a plan covering the medication (Correct answer)

Correct answer: Review the Annual Notice of Change and use the AEP to switch to a plan covering the medication

The Annual Notice of Change alerts beneficiaries to plan changes, and the Annual Enrollment Period (Oct 15–Dec 7) is the time to switch to a better-fitting plan for the new year.

Question 5: Which income threshold generally determines whether a low-income individual qualifies for Medicaid expansion versus a premium tax credit on the marketplace in expansion states?

Below 100% FPL qualifies for Medicaid; 200–500% FPL qualifies for marketplace subsidies
Premium tax credits are available only above 300% FPL to avoid Medicaid duplication
Medicaid covers all incomes under 200% FPL in all states
Below 138% FPL qualifies for Medicaid; 100–400% FPL (and above with ARPA) qualifies for marketplace premium tax credits (Correct answer)

Correct answer: Below 138% FPL qualifies for Medicaid; 100–400% FPL (and above with ARPA) qualifies for marketplace premium tax credits

In Medicaid expansion states, adults with incomes up to 138% FPL qualify for Medicaid; those above 100% FPL (up to the applicable cap) may qualify for marketplace premium tax credits.

Question 6: Under 45 CFR § 155.260, a core regulation for Marketplace privacy and security, a CEC must only collect, use, and disclose a consumer's Personally Identifiable Information (PII) to the extent necessary to perform which of the following?

Share with local insurance brokers who may offer better plans.
Provide to community partners for outreach and fundraising purposes.
Conduct market research for the Certified Enrollment Entity.
Fulfill authorized functions like assisting with eligibility and enrollment. (Correct answer)

Correct answer: Fulfill authorized functions like assisting with eligibility and enrollment.

45 CFR § 155.260 and related CMS guidance strictly limit the use of a consumer's PII to the functions necessary for the efficient operation of the Marketplace. For a CEC, this means using the information solely for authorized activities such as helping a consumer determine eligibility and enroll in a Qualified Health Plan or insurance affordability program. Using PII for marketing, research, or fundraising is a violation of these standards.

Question 7: Which statement best describes the Special Enrollment Period available to beneficiaries who involuntarily lose employer-sponsored health coverage?

They must wait until the General Enrollment Period running January 1–March 31
They automatically receive Medicare coverage the day their employer coverage ends
They have 30 days from the loss of coverage to enroll in Medicare Parts A and B
They have an 8-month SEP to enroll in Medicare Part B after losing employer coverage (Correct answer)

Correct answer: They have an 8-month SEP to enroll in Medicare Part B after losing employer coverage

Beneficiaries who lose employer-sponsored group health plan coverage have an 8-month Special Enrollment Period to enroll in Medicare Part B without a late enrollment penalty.

Question 8: What is the role of a State Health Insurance Assistance Program (SHIP) counselor in the post-enrollment process?

To process Medicare claims and resolve billing disputes on behalf of CMS
To administer the Medicare Savings Program enrollment process
To sell Medicare Advantage and Part D plans to beneficiaries on behalf of insurance companies
To provide free, unbiased Medicare counseling to help beneficiaries understand their rights and options (Correct answer)

Correct answer: To provide free, unbiased Medicare counseling to help beneficiaries understand their rights and options

SHIP counselors provide free, unbiased, one-on-one assistance to Medicare beneficiaries, helping them understand coverage options, appeals rights, and post-enrollment issues.

Question 9: What is the significance of the 'right to amend' under HIPAA for enrollment applicants?

Applicants have the right to delete all records after coverage ends
Applicants can change their plan selection at any time without a qualifying event
Applicants can amend their subsidy amount after enrollment closes
Applicants may request corrections to inaccurate PHI in their records (Correct answer)

Correct answer: Applicants may request corrections to inaccurate PHI in their records

The right to amend allows individuals to request corrections to inaccurate or incomplete PHI held by a covered entity.

Question 10: What is the Advance Premium Tax Credit (APTC)?

A tax credit only claimed when filing annual returns
A reimbursement for out-of-pocket medical costs
A subsidy paid in advance to lower monthly Marketplace premiums (Correct answer)
A tax penalty for not having health insurance

Correct answer: A subsidy paid in advance to lower monthly Marketplace premiums

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

Question 11: What document must Medicare Advantage and Part D plans send to enrollees each September?

Medicare & You handbook
Evidence of Coverage (EOC)
Annual Notice of Change (ANOC) (Correct answer)
Summary of Benefits (SOB)

Correct answer: Annual Notice of Change (ANOC)

Plans must send the Annual Notice of Change (ANOC) by September 30 each year, informing members of any changes taking effect on January 1.

Question 12: What is the income range for premium tax credit eligibility on the Marketplace (after the ARP 2021 expansions made permanent)?

100% FPL and above with no upper cap (Correct answer)
100%–250% FPL
100%–300% FPL
100%–400% FPL

Correct answer: 100% FPL and above with no upper cap

Under the Inflation Reduction Act, the upper income cap on APTC was eliminated; anyone above 100% FPL (400%+ FPL) may qualify if premiums exceed the benchmark percentage of income.

Question 13: A 28-year-old consumer is looking for a health plan with the lowest possible monthly premium, and they do not expect to need frequent medical services. Which metal level plan would most likely meet their primary objective?

Platinum
Gold
Silver
Bronze (Correct answer)

Correct answer: Bronze

Bronze plans are characterized by having the lowest monthly premiums. In exchange, they have the highest out-of-pocket costs (like deductibles and copayments) when care is needed. This structure is often suitable for younger, healthier individuals who want protection from major medical events but want to keep fixed monthly costs low.

Question 14: Which metal tier plans are eligible for Cost-Sharing Reductions (CSR)?

Silver plans only (Correct answer)
Gold and Platinum plans
Any metal tier plan
Bronze plans only

Correct answer: Silver plans only

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

Question 15: During the annual redetermination process, the Marketplace automatically re-enrolls a consumer into a plan for the upcoming year. What information does the Marketplace primarily use to redetermine eligibility for financial assistance if the consumer takes no action?

Self-attested information provided over the phone by the consumer during the previous year.
The consumer's credit score and financial history.
Information from the previous year's application, adjusted for FPL changes and updated income data from sources like the IRS. (Correct answer)
A standard default income amount set by the state.

Correct answer: Information from the previous year's application, adjusted for FPL changes and updated income data from sources like the IRS.

For consumers who do not actively update their application, the Marketplace uses an alternative procedure for annual redetermination. This involves using the most recent income information available from data sources like the IRS, projecting it for the upcoming year, and adjusting it based on updated Federal Poverty Level (FPL) tables and benchmark plan premiums to calculate financial assistance.

Question 16: A 35-year-old applicant earns 150% of FPL and qualifies for Medicaid in an expansion state. What should an enrollment counselor advise?

Enroll in a Bronze Marketplace plan
Use a Catastrophic plan instead
Apply for Medicaid immediately (Correct answer)
Wait until Open Enrollment

Correct answer: Apply for Medicaid immediately

Individuals who qualify for Medicaid should apply for Medicaid, as they cannot receive premium tax credits if they are eligible for Medicaid.

Question 17: What is 'reconciliation' in the context of the Advance Premium Tax Credit?

Renewing enrollment for the next plan year
Verifying a consumer's identity with the Marketplace
The process of switching plans mid-year
Comparing APTC received to the actual credit owed based on final income (Correct answer)

Correct answer: Comparing APTC received to the actual credit owed based on final income

Reconciliation is the process on Form 8962 where the APTC paid throughout the year is compared against the actual premium tax credit based on final reported income.

Question 18: Under the ACA's individual mandate (before the penalty was reduced to $0 in 2019), what was the primary enforcement mechanism?

Criminal prosecution by the Department of Justice
A shared responsibility payment collected through the federal tax return (Correct answer)
Loss of Medicaid eligibility
Denial of Marketplace enrollment in future years

Correct answer: A shared responsibility payment collected through the federal tax return

The individual mandate was enforced via a 'shared responsibility payment' (tax penalty) assessed on the federal income tax return for those without MEC.

Question 19: The Advance Premium Tax Credit (APTC) is paid directly to whom?

The enrollee's employer
The health insurance company on the enrollee's behalf (Correct answer)
The enrollee as a tax refund
CMS for deposit into a federal fund

Correct answer: The health insurance company on the enrollee's behalf

APTC is paid directly to the insurance company, reducing the enrollee's monthly premium amount owed.

Question 20: What does the term 'health literacy' mean in the context of serving diverse populations?

An individual's ability to obtain, process, and understand basic health information needed to make appropriate health decisions (Correct answer)
A client's proficiency in reading English-language insurance documents
A counselor's knowledge of health insurance regulations
The number of languages in which a health plan offers materials

Correct answer: An individual's ability to obtain, process, and understand basic health information needed to make appropriate health decisions

Health literacy refers to the degree to which individuals can obtain, process, and understand health information and services needed to make informed decisions.

Question 21: Which of the following qualifying life events triggers a Special Enrollment Period?

Being diagnosed with a chronic illness
Moving to a new county with different plan options (Correct answer)
Voluntarily canceling prior health coverage
Choosing to retire early before age 65

Correct answer: Moving to a new county with different plan options

Moving to a new service area with different Marketplace plan options is a qualifying life event that triggers a 60-day Special Enrollment Period.

Question 22: Cost-Sharing Reductions (CSR) lower which of the following for eligible consumers?

Federal income taxes
Monthly premiums
Annual enrollment fees
Deductibles, copayments, and out-of-pocket maximums (Correct answer)

Correct answer: Deductibles, copayments, and out-of-pocket maximums

CSR reduces cost-sharing amounts such as deductibles, copays, and out-of-pocket maximums for eligible consumers enrolled in Silver plans.

Question 23: A client discloses an undocumented immigration status. What coverage options should the enrollment counselor explain?

Undocumented individuals qualify for the same marketplace subsidies as U.S. citizens
Undocumented individuals are not eligible for marketplace or Medicaid coverage but may qualify for emergency Medicaid and some state-funded programs (Correct answer)
Undocumented individuals qualify for Medicare if they have paid taxes for five years
Undocumented individuals are automatically enrolled in Medicaid upon presenting at a health facility

Correct answer: Undocumented individuals are not eligible for marketplace or Medicaid coverage but may qualify for emergency Medicaid and some state-funded programs

Federal law bars undocumented immigrants from marketplace enrollment and most Medicaid, but emergency Medicaid is available and some states fund additional coverage with state-only dollars.

Question 24: When determining the projected annual income for a migrant farmworker whose income is irregular and seasonal, what is the most appropriate method for a CEC to use?

Ask the consumer to provide a reasonable, good-faith estimate of their total expected income for the entire coverage year, using past earnings and expected work as a guide. (Correct answer)
Use the income from their most recent paycheck and multiply it by 52.
Advise the consumer to report zero income, as their work is not guaranteed for the full year.
Only include income earned within the state where they are applying for coverage.

Correct answer: Ask the consumer to provide a reasonable, good-faith estimate of their total expected income for the entire coverage year, using past earnings and expected work as a guide.

For individuals with fluctuating or seasonal income, the Marketplace requires a good-faith estimate of their total expected income for the coverage year. This method is the most accurate for determining eligibility for financial assistance. Consumers should be advised to update their income information if their circumstances change significantly during the year.

Question 25: Which consumers are NOT eligible for premium tax credits on the Marketplace?

Retirees under age 65 with no Medicare
Individuals eligible for affordable employer-sponsored insurance (Correct answer)
Part-time workers without employer coverage
Self-employed individuals earning 200% FPL

Correct answer: Individuals eligible for affordable employer-sponsored insurance

Consumers who are offered affordable, minimum-value employer-sponsored insurance are not eligible for APTC, even if they choose not to enroll in the employer plan.

Question 26: A consumer wants to enroll their 26-year-old child on their Marketplace family plan. Is this permitted under ACA rules?

No, adult children must always have their own separate plan
Yes, adult children up to age 30 can be covered on a parent's plan
Yes, adult children of any age can be added to a parent's Marketplace plan
No, Marketplace family plans can only include tax dependents, and a 26-year-old is generally not a tax dependent (Correct answer)

Correct answer: No, Marketplace family plans can only include tax dependents, and a 26-year-old is generally not a tax dependent

Marketplace family plans cover tax dependents; a 26-year-old who is not a tax dependent of the parent cannot be included on the parent's Marketplace application.

Question 27: What role does a Silver plan play in the Cost-Sharing Reduction system?

It is the cheapest plan and automatically qualifies all enrollees for CSR
It is required for all Medicaid-eligible consumers
It is the only plan tier through which CSR benefits are delivered (Correct answer)
It provides the highest premium tax credits of any metal tier

Correct answer: It is the only plan tier through which CSR benefits are delivered

Silver plans are the only plans that carry CSR variants, making Silver the delivery vehicle for all cost-sharing reduction benefits on the Marketplace.

Question 28: Which of the following practices best demonstrates an enrollment counselor's commitment to ethical marketing?

Providing accurate graduation rates and employment outcomes as reported under federal disclosure requirements (Correct answer)
Omitting information about loan default rates to avoid discouraging applicants
Targeting vulnerable populations with aggressive recruitment tactics
Emphasizing only positive job placement statistics without context

Correct answer: Providing accurate graduation rates and employment outcomes as reported under federal disclosure requirements

Ethical marketing requires presenting accurate, federally mandated disclosures such as graduation rates and employment outcomes so prospective students can make informed decisions.

Question 29: Which of the following best illustrates an ethical use of persuasion in enrollment counseling?

Highlighting verified program strengths that are genuinely relevant to the student's stated goals (Correct answer)
Offering unofficial tuition discounts not reflected in official materials
Creating artificial urgency by falsely claiming seats are almost full
Withholding negative outcome data to maintain enthusiasm

Correct answer: Highlighting verified program strengths that are genuinely relevant to the student's stated goals

Ethical persuasion uses truthful, relevant information aligned with the student's goals rather than manipulation or deception.

Question 30: A beneficiary enrolled in a Medicare Part D plan reaches the catastrophic coverage phase. What happens to their cost-sharing at this stage?

They are disenrolled and must reapply
They pay 100% of drug costs until the end of the year
They pay a small copay or coinsurance and the plan covers the rest (Correct answer)
They must switch to a different formulary tier

Correct answer: They pay a small copay or coinsurance and the plan covers the rest

In the catastrophic coverage phase, beneficiaries pay significantly reduced cost-sharing (small copay or 5% coinsurance) and the plan covers the majority of drug costs.

Question 31: What is the 'affordability threshold' used to determine if employer-sponsored insurance blocks APTC eligibility?

The plan has a deductible over $1,000
The employer contributes less than 50% of premium costs
Premiums exceed 5% of household income
Premiums exceed the IRS-set percentage of household income for self-only coverage (Correct answer)

Correct answer: Premiums exceed the IRS-set percentage of household income for self-only coverage

ESI is considered unaffordable, and APTC eligibility is preserved, if the employee's share of self-only premium exceeds the IRS-published affordability percentage of household income.

Question 32: During the annual renewal period, a consumer who takes no action is automatically re-enrolled. However, their specific 2025 plan is being discontinued by the insurer. What is the most likely action the Marketplace will take?

Send a notice that the consumer must select a new plan within 30 days or they will have a gap in coverage.
Terminate the consumer's coverage and financial assistance.
Automatically enroll the consumer into a similar plan from the same insurer, or a different insurer if a similar plan is not available from the original one. (Correct answer)
Automatically enroll the consumer into the lowest-cost Bronze plan available.

Correct answer: Automatically enroll the consumer into a similar plan from the same insurer, or a different insurer if a similar plan is not available from the original one.

If a consumer's plan is discontinued, the Marketplace will automatically re-enroll them in a new plan that is as similar as possible to their previous one, a process often called a "crosswalk." The priority is to find a similar plan from the same insurance company first. If that's not possible, it will look for a similar plan from a different insurer. This prevents a gap in coverage for the consumer.

Question 33: How does the Marketplace treat verification for American Indians and Alaska Natives (AI/ANs) who are exempt from the individual shared responsibility payment?

They must submit a tribal enrollment certificate to access zero cost-sharing plans (Correct answer)
They must submit a federal tax return to verify tribal income
No documentation is required; self-attestation is always sufficient
AI/ANs are ineligible for Marketplace plans

Correct answer: They must submit a tribal enrollment certificate to access zero cost-sharing plans

American Indians and Alaska Natives who wish to access zero cost-sharing Marketplace plans typically need to submit a tribal enrollment certificate or other documentation confirming membership in a federally recognized tribe.

Question 34: Which IRS form is used to reconcile and claim the premium tax credit when filing federal taxes?

Form 8965
Form 8962 (Correct answer)
Form 1095-A
Schedule C

Correct answer: Form 8962

Form 8962 (Premium Tax Credit) is attached to the federal tax return to reconcile the APTC received with the actual credit owed based on final income.

Question 35: What is a 'passive renewal' in the context of Marketplace enrollment?

A state-mandated enrollment renewal process
Automatic re-enrollment into the same or similar plan if the consumer takes no action during Open Enrollment (Correct answer)
A consumer actively re-selecting the same plan each year
An insurer automatically upgrading a consumer to a higher-tier plan

Correct answer: Automatic re-enrollment into the same or similar plan if the consumer takes no action during Open Enrollment

Passive renewal means the Marketplace automatically re-enrolls consumers who do not make an active plan selection during Open Enrollment, often into the same plan.

Question 36: Which of the following individuals is categorically excluded from Marketplace coverage?

A retiree under 65 not yet on Medicare
A 25-year-old on a parent's plan who also wants their own plan
An undocumented immigrant (Correct answer)
A self-employed person with no employer offer

Correct answer: An undocumented immigrant

Undocumented immigrants are not eligible to enroll in Marketplace plans or receive premium tax credits under the ACA.

Question 37: An enrollment counselor's client asks about the Medicare Savings Programs. Which statement is accurate?

They are employer-sponsored plans that supplement Medicare coverage
They are federal programs that help low-income beneficiaries pay Medicare premiums and cost-sharing (Correct answer)
They are available only to beneficiaries under age 65 with disabilities
They replace Medicaid for Medicare-eligible individuals

Correct answer: They are federal programs that help low-income beneficiaries pay Medicare premiums and cost-sharing

Medicare Savings Programs are state-administered, federally funded programs that assist low-income beneficiaries with Medicare Part A and/or Part B premiums, deductibles, and copayments.

Question 38: What income range (as a percentage of the Federal Poverty Level) makes a consumer eligible for the Advance Premium Tax Credit?

0–100% FPL
100–400% FPL (Correct answer)
138–400% FPL
200–600% FPL

Correct answer: 100–400% FPL

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

Question 39: A beneficiary's Medicare Advantage plan denies a prior authorization request for a specialist visit. What immediate right does the beneficiary have?

They must wait until the AEP to address the denial
They have the right to request an expedited or standard appeal of the denial (Correct answer)
They must ask their PCP to resubmit the authorization request three times before appealing
They must obtain the service out-of-pocket and seek reimbursement later

Correct answer: They have the right to request an expedited or standard appeal of the denial

When a Medicare Advantage plan denies a prior authorization, beneficiaries have the right to file a standard or expedited appeal asking the plan to reconsider the decision.

Question 40: A counselor suspects a colleague is systematically misrepresenting transfer credit policies to boost enrollment numbers. The appropriate action is to:

Adopt the same approach to remain competitive
Report the suspected misconduct to supervisors or a compliance office per institutional policy (Correct answer)
Ignore it as it is not their responsibility
Confront the colleague privately and take no further action

Correct answer: Report the suspected misconduct to supervisors or a compliance office per institutional policy

Enrollment counselors have an ethical obligation to report suspected misconduct through the appropriate institutional channels.

Question 41: Which tax form does a consumer receive to reconcile their APTC at tax time?

Form W-2
Form 1095-A (Correct answer)
Form 1040-EZ
Form 8962 only

Correct answer: Form 1095-A

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

Question 42: Which verification scenario requires the Marketplace to check DHS immigration records through the Federal Data Services Hub?

A child under age 18 applying with a parent who is a U.S. citizen
A Medicare beneficiary applying for a supplemental plan
A lawfully present non-citizen claiming eligibility based on immigration status (Correct answer)
A U.S.-born citizen applying with a passport

Correct answer: A lawfully present non-citizen claiming eligibility based on immigration status

For non-citizens claiming lawful presence, the Marketplace queries DHS records via the Federal Data Services Hub to electronically verify the immigration status information provided on the application.

Question 43: A client who recently turned 26 and aged off their parent's plan is from a low-income household. What should the enrollment counselor assess first?

Whether Medicare is available since the client just experienced a qualifying life event
Current income to determine Medicaid eligibility or marketplace subsidy eligibility, since aging off a parent's plan is a qualifying SEP trigger (Correct answer)
Whether the client can rejoin the parent's plan because age-out is reversible
Whether the client qualifies for COBRA continuation from the parent's plan as the only option

Correct answer: Current income to determine Medicaid eligibility or marketplace subsidy eligibility, since aging off a parent's plan is a qualifying SEP trigger

Turning 26 and losing dependent coverage is a qualifying life event triggering a marketplace SEP, and income assessment determines whether Medicaid or subsidized marketplace coverage is more appropriate.

Question 44: When assisting a consumer with a Marketplace application, which of the following pieces of information is required for every member of the household, even those not applying for coverage?

Specific medical history
Previous health insurance policy numbers
Social Security numbers (Correct answer)
Driver's license numbers

Correct answer: Social Security numbers

The Marketplace application requires Social Security numbers for everyone in the household, including those not seeking coverage, to verify income and household information for eligibility determinations.

Question 45: A consumer loses their employer-sponsored health coverage on June 15th. Under ACA rules, what is the latest date they can typically enroll in a new Marketplace plan through a Special Enrollment Period (SEP)?

December 15th
July 15th
August 14th (Correct answer)
June 30th

Correct answer: August 14th

Losing qualifying health coverage is a life event that triggers a Special Enrollment Period. Generally, individuals have 60 days from the date of losing coverage to select a new Marketplace plan. Therefore, 60 days from June 15th is August 14th.

Question 46: Which of the following life events would typically NOT trigger a Special Enrollment Period (SEP) for Marketplace coverage?

Having a baby
Losing health coverage due to a permanent move to a new zip code
Voluntarily dropping existing employer-sponsored coverage (Correct answer)
Getting married

Correct answer: Voluntarily dropping existing employer-sponsored coverage

Voluntarily dropping existing health coverage, such as an employer-sponsored plan, does not qualify an individual for a Special Enrollment Period. SEPs are generally triggered by involuntary loss of coverage or specific life changes like marriage, birth, or a qualifying move.

Question 47: At what Federal Poverty Level percentage does APTC eligibility begin for most Marketplace consumers?

133% FPL
100% FPL (Correct answer)
50% FPL
138% FPL

Correct answer: 100% FPL

APTC eligibility generally starts at 100% FPL for consumers who are not eligible for Medicaid.

Question 48: Which of the following best describes the enrollment counselor's obligation regarding consumer privacy when handling application information?

Consumer information may be shared freely with other agencies to streamline enrollment
Privacy rules only apply to health information, not financial information collected during enrollment
Counselors are not bound by privacy requirements since they are volunteers
Enrollment counselors must safeguard all consumer information, use it only for authorized purposes, and comply with federal and state privacy laws (Correct answer)

Correct answer: Enrollment counselors must safeguard all consumer information, use it only for authorized purposes, and comply with federal and state privacy laws

Enrollment counselors are obligated to protect all consumer information—including financial and health data—under federal privacy laws and their certification requirements.

Question 49: A client expresses fear that enrollment information will be shared with immigration authorities. What should the counselor say?

Information provided on a marketplace application is protected and is not shared with immigration enforcement agencies (Correct answer)
All application data is automatically reported to DHS for verification of immigration status
Only income information is protected; immigration status data is routinely shared with ICE
The counselor cannot make any assurances about data privacy

Correct answer: Information provided on a marketplace application is protected and is not shared with immigration enforcement agencies

CMS has confirmed that marketplace application information is protected by law and is not used for immigration enforcement purposes.

Question 50: How does APTC affect a consumer's monthly premium payments?

It is deposited into the consumer's bank account monthly
It applies only after the deductible is met
It doubles the premium cost in the first month
It reduces the monthly premium the consumer pays by applying the credit directly to the insurer (Correct answer)

Correct answer: It reduces the monthly premium the consumer pays by applying the credit directly to the insurer

APTC is paid directly to the insurer each month, reducing the net premium the consumer owes.

Question 51: An applicant is a U.S. citizen living abroad permanently. Are they eligible for Marketplace coverage?

Only if they are over 65
No, they must reside in the United States to enroll (Correct answer)
Yes, if their income is below 400% FPL
Yes, if they pay U.S. taxes

Correct answer: No, they must reside in the United States to enroll

Marketplace eligibility requires residing in the United States; U.S. citizens living abroad are not eligible to enroll in Marketplace plans.

Question 52: A Navigator is different from a licensed insurance agent/broker in that Navigators:

Provide unbiased education and assistance but cannot recommend specific plans or receive compensation tied to enrollment (Correct answer)
Are only authorized to assist Medicaid applicants
Can sell plans and receive commissions
Must be employed by a health insurance company

Correct answer: Provide unbiased education and assistance but cannot recommend specific plans or receive compensation tied to enrollment

Navigators provide free, unbiased enrollment assistance and education but are prohibited from recommending specific plans or accepting compensation from insurers.

Question 53: A recently released incarcerated individual asks about marketplace enrollment. What should the enrollment counselor advise regarding their SEP eligibility?

Release from incarceration qualifies as a life event triggering a 60-day SEP for marketplace enrollment (Correct answer)
They are automatically enrolled in Medicare upon release
They qualify only for Medicaid if their income is below 100% FPL
They must wait until the next open enrollment period because incarceration is not a qualifying life event

Correct answer: Release from incarceration qualifies as a life event triggering a 60-day SEP for marketplace enrollment

Release from incarceration is a qualifying life event that triggers a 60-day special enrollment period for marketplace plans.

Question 54: A beneficiary moving into a nursing home asks about Medicare coverage for skilled nursing facility care. What is required for Medicare Part A to cover SNF care?

Prior authorization from Medicare and a minimum of 30 days of Part A enrollment
A physician's recommendation and payment of the Part B deductible
Enrollment in a Medicare Advantage plan with SNF benefits
A qualifying 3-day inpatient hospital stay and a skilled care need (Correct answer)

Correct answer: A qualifying 3-day inpatient hospital stay and a skilled care need

Medicare Part A covers SNF care only after a qualifying 3-consecutive-day inpatient hospital stay and only when skilled nursing or therapy services are medically necessary.

Question 55: A consumer enrolling on November 20 during Open Enrollment selects a plan. When does their coverage begin if no earlier start date applies?

February 1 of the following year
November 30 of that year
January 1 of the following year (Correct answer)
December 1 of that year

Correct answer: January 1 of the following year

Enrollments completed between December 16 and January 15 have a February 1 effective date, but a November 20 enrollment results in a January 1 effective date.

Question 56: Which of the following best describes the 'assister attestation' requirement when registering as a CAC?

The CAC's agreement to comply with all applicable laws, regulations, and program requirements (Correct answer)
The organization's attestation that it has no outstanding tax liabilities
The insurer's confirmation that the CAC is authorized to enroll their plans
The consumer's signature confirming enrollment

Correct answer: The CAC's agreement to comply with all applicable laws, regulations, and program requirements

Assister attestation is the formal agreement by CACs to abide by all applicable federal and state laws, regulations, and program standards as a condition of certification.

Question 57: A consumer who qualifies for Cost-Sharing Reductions must enroll in which metal tier to receive the benefit?

Bronze
Platinum
Gold
Silver (Correct answer)

Correct answer: Silver

CSR benefits are only applied to Silver-tier plans; enrolling in any other tier forfeits the cost-sharing reduction benefit.

Question 58: Which form does an insurer use to report Marketplace coverage to the IRS and send to enrollees for tax filing purposes?

Form W-2
Form 1095-B
Form 1095-C
Form 1095-A (Correct answer)

Correct answer: Form 1095-A

Form 1095-A (Health Insurance Marketplace Statement) is issued by the Marketplace to enrollees and is required to complete Form 8962 for APTC reconciliation.

Question 59: A consumer who received APTC during the year reports a significant income increase when filing taxes. What is the likely outcome?

There is no financial consequence for income changes
The IRS automatically adjusts the APTC without any consumer action
The consumer may need to repay some or all of the excess APTC received, subject to repayment caps for lower incomes (Correct answer)
The consumer receives a larger refund for the excess subsidies

Correct answer: The consumer may need to repay some or all of the excess APTC received, subject to repayment caps for lower incomes

When final income exceeds the estimated amount, consumers must repay excess APTC on Form 8962, though repayment caps apply for incomes below 400% FPL.

Question 60: Under FERPA, which of the following is considered 'directory information' that may be disclosed without consent unless the student opts out?

Grades and GPA records
Disciplinary records and medical information
Student's name, address, and enrollment status (Correct answer)
Social Security number and financial aid amount

Correct answer: Student's name, address, and enrollment status

FERPA permits schools to designate certain non-sensitive data such as name, address, and enrollment status as directory information, which may be released without prior consent unless the student opts out.

Question 61: Which document is essential to verify income during enrollment?

Social media profile
Recent pay stub or tax return (Correct answer)
School transcript
Library card

Correct answer: Recent pay stub or tax return

To verify income during enrollment, essential documentation includes a recent pay stub or a tax return. These documents provide official proof of earnings, which is critical for accurately determining a client's eligibility for income-based health coverage programs and subsidies, ensuring they receive the correct financial assistance.

Question 62: What does 'duty of care' require of a Certified Enrollment Counselor when working with vulnerable populations such as first-generation college students?

Providing additional context, resources, and support to ensure fully informed decisions (Correct answer)
Limiting communication to avoid overwhelming the student
Expediting the enrollment process to reduce confusion
Applying standard practices without modification

Correct answer: Providing additional context, resources, and support to ensure fully informed decisions

Duty of care requires counselors to adapt their approach and provide enhanced support to ensure vulnerable students can make genuinely informed decisions.

Question 63: Which of the following actions violates the ethical obligation of confidentiality in enrollment counseling?

Using aggregated, de-identified enrollment data in institutional reports
Sharing a student's health condition revealed during counseling with admissions committee members uninvolved in accommodation decisions (Correct answer)
Discussing a student's application with a supervisor who needs it to process admission
Storing encrypted applicant records on a secured institutional server

Correct answer: Sharing a student's health condition revealed during counseling with admissions committee members uninvolved in accommodation decisions

Sharing a student's health information disclosed in confidence with individuals who have no need for it violates confidentiality and may also implicate HIPAA or ADA privacy protections.

Question 64: An applicant's household includes a non-citizen spouse who is ineligible for Marketplace coverage. How is household income calculated for APTC purposes?

The non-citizen spouse's income is excluded entirely
Only the income of citizens in the household is counted
All household members' income is counted regardless of immigration status
The non-citizen spouse's income is counted but their coverage need is excluded (Correct answer)

Correct answer: The non-citizen spouse's income is counted but their coverage need is excluded

The non-citizen spouse's income is included in MAGI household income but they are not counted in the tax family size for benchmark plan calculation.

Question 65: Under the Americans with Disabilities Act (ADA), a Certified Enrollment Counselor's organization is required to provide 'reasonable accommodations' for consumers with disabilities. Which of the following is the best example of a reasonable accommodation?

Providing a qualified American Sign Language (ASL) interpreter for a deaf consumer during an appointment. (Correct answer)
Offering a discount on the plan premium for individuals with documented disabilities.
Completing the entire application on the consumer's behalf without their direct input.
Recommending only plans that have the best coverage for the consumer's specific disability.

Correct answer: Providing a qualified American Sign Language (ASL) interpreter for a deaf consumer during an appointment.

A reasonable accommodation is a modification or adjustment that enables an individual with a disability to have equal opportunity and access to services. Providing an ASL interpreter is a form of an auxiliary aid that ensures effective communication, which is a core part of the service. The other options are either prohibited (A), outside the CEC's scope (B), or inappropriate (D).

Question 66: What is the minimum income level (as % FPL) required for APTC eligibility in states without Medicaid expansion?

100% FPL (Correct answer)
138% FPL
133% FPL
50% FPL

Correct answer: 100% FPL

In non-Medicaid-expansion states, consumers at 100% FPL and above may qualify for APTC if they are not eligible for other minimum essential coverage.

Question 67: Under the ACA, what is the maximum annual out-of-pocket limit for a self-only Marketplace plan in 2024?

$5,500
$12,200
$7,500
$9,450 (Correct answer)

Correct answer: $9,450

For 2024, the ACA out-of-pocket maximum for self-only coverage is $9,450, limiting total cost-sharing exposure for in-network essential health benefits.

Question 68: Which of the following is considered Minimum Essential Coverage (MEC) under the ACA?

Employer-sponsored group health plans (Correct answer)
Short-term health plans
Vision-only insurance
Excepted benefit dental-only plans

Correct answer: Employer-sponsored group health plans

Employer-sponsored group health plans that meet ACA standards qualify as Minimum Essential Coverage.

Question 69: A family of four applies for coverage. The parents are lawfully present immigrants who are not yet eligible for Medicaid due to the five-year waiting period. Their two children were born in the U.S. and are citizens. Their household income is 80% of the Federal Poverty Level (FPL). How will the eligibility of the parents likely be treated for Marketplace financial assistance?

They will be referred to their state's emergency medical assistance program only.
They will be ineligible for any financial assistance because their income is below 100% FPL.
They must wait until they meet the five-year bar to receive any form of assistance.
They will be eligible for Advance Premium Tax Credits (APTC) despite their income being below 100% FPL. (Correct answer)

Correct answer: They will be eligible for Advance Premium Tax Credits (APTC) despite their income being below 100% FPL.

Lawfully present immigrants who are ineligible for Medicaid due to their immigration status may qualify for financial assistance like APTC through the Marketplace, even if their household income is below 100% of the FPL. This rule prevents a gap in coverage for this specific population.

Question 70: What happens when a consumer's actual year-end income is higher than the income they estimated when enrolling?

They may owe back some or all of the excess APTC received (Correct answer)
They automatically receive a larger credit next year
Their plan is retroactively terminated
They keep the full APTC with no adjustment

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

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

Question 71: Which state runs its own fully state-based Marketplace (SBM) and does NOT use HealthCare.gov for enrollment?

Texas
Florida
Georgia
California (Correct answer)

Correct answer: California

California operates Covered California, a fully state-based Marketplace with its own enrollment platform separate from HealthCare.gov.

Question 72: A prospective student discloses a mental health condition during an enrollment conversation. How should the counselor handle this information?

Share it with admissions committee members to assess fitness
Document it in the public enrollment file
Keep it confidential and refer the student to appropriate campus support services (Correct answer)
Use it to determine whether to encourage enrollment

Correct answer: Keep it confidential and refer the student to appropriate campus support services

Sensitive personal disclosures must remain confidential and be handled by referring students to qualified support services.

Question 73: What is the purpose of the Medicare Advantage plan's Evidence of Coverage (EOC) document?

To list all in-network providers available in the service area
To provide a comprehensive description of covered benefits, costs, and rules for the plan year (Correct answer)
To serve as proof of premium payment for tax purposes
To notify beneficiaries of changes to their plan for the upcoming year

Correct answer: To provide a comprehensive description of covered benefits, costs, and rules for the plan year

The Evidence of Coverage (EOC) is a detailed document that explains all covered services, costs, prior authorization requirements, and rules for the enrollee's plan during the current benefit year.

Question 74: An enrollment counselor discovers that a consumer has provided fraudulent information on their Marketplace application. What is the counselor's correct course of action?

Ignore it if the consumer insists the information is correct
Refuse to assist and advise the consumer to provide accurate information (Correct answer)
Complete the application and report it later
Submit the application but note the discrepancy internally

Correct answer: Refuse to assist and advise the consumer to provide accurate information

Enrollment counselors must refuse to knowingly assist with fraudulent applications and should advise consumers to provide only accurate and truthful information.

Question 75: Which federal agency oversees the Health Insurance Marketplace established under the ACA?

Centers for Medicare & Medicaid Services (CMS) (Correct answer)
Office of Personnel Management
Social Security Administration
Department of Labor

Correct answer: Centers for Medicare & Medicaid Services (CMS)

CMS is the federal agency responsible for administering and overseeing the ACA's Health Insurance Marketplace.

Covered California Certified Enrollment Counselor (CEC) Certification Exam

The CEC certification exam tests knowledge required to assist California consumers with enrolling in health coverage through Covered California and Medi-Cal, including ACA rules, eligibility, financial assistance, privacy regulations, and serving diverse populations. Administered by Covered California, candidates must score 80% or higher to earn certification.

Questions

90 min

Time Limit

80%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds