Indiana Navigator Test Study Guide
2025/2026
3 month retroactive eligibility does not apply to - ANS-HIP or CHIP
A complaint about an IN Nav can be made to the IDOI and will be processed within - ANS-72
hours
A federally-designated consumer assistant may be which of the following? - ANS-Certified
Application Counselor (CAC), Federal Navigator, or a Producer (Broker and/or Agent)
A pregnant woman does not count the number of children she is expecting when determining
household size for MAGI? - ANS-False- she counts herself plus the number of children she is
expecting
ACA insurance market changes - ANS-1. ensure premiums pay healthcare costs
2. state reviews all premium rate increases
3. premiums based on age, location, tobacco/smoking status, and family status (# of people in
household)
4. guaranteed availability and renewability
5. adult dependent coverage until 26
6. expanded coverage for preventative services (many required to be covered w/out cost
sharing)
7. Essential Health Benefits (EHBs)
8. elimination of lifetime and annual maximum coverage limits for EHB coverage
Actuarial Value (AV) - ANS-indicates the average percentage of plan charges the insurer
expects to pay for ALL enrollees in that plan. the higher the AV, the higher the premium but
lower the cost sharing
Actuarial Value (AV) Statistics by tier - ANS-1. bronze 60%
2. silver 70%
3. gold 80%
4. platinum (not available in IN) 90%
Advanced Premium Tax Credit (APTC) - ANS-credits paid directly to insurance company to
reduce individual's premium costs
After close to 12 months, QHPs will send a re-enrollment notice to consumers stating they will
be automatically re-enrolled in their current plan as long as their info meets eligibility
requirements. - ANS-True- but consumers should evaluate all coverage options in case they
qualify for something that they didn't last time. Information may also need to be updated.
An individual cannot be an Indiana Navigator if: - ANS-1. They have been denied, suspended,
or revoked of an insurance agent/broker license, IN Navigator Certification, or an equivalent
license certification
2. They have been convicted of a disqualifying felony or crime as determined by the
Commissioner of Insurance
,3. They have been convicted of unfair trade practice or fraud in insurance business
4. They have an unpaid state income tax or child support obligation
An unborn child counts toward family size for which programs? - ANS-Presumptive Eligibility
and/or Hoosier Healthwise
Applicants are considered disabled when applying for FFM plans if they receive Social Security
Disability Insurance (SSDI) or Supplemental Security Income (SSI)? - ANS-true
application inconsistency or data matching issue (DMI) occurs when? - ANS-when FFMs cannot
verify electronic information through trusted data sources and applicants have to submit
documentation
Are Native Americans required to pay cost sharing fees when enrolled in HIP? - ANS-No, by
federal rule they are exempt from cost sharing.
Are undocumented individuals eligible for Medicaid coverage? - ANS-Yes and no: they are
eligible for Emergency Services only through their selected program, but they still have to meet
the eligibility requirements for the selected plan (Medicaid)
Batch Auto Re-enrollment (BAR) is... - ANS-the auto re-enrollment process that
marketplace/FFM uses to ensure enrollees continue to have coverage if they do not make an
active plan selection
Besides children, who does Hoosier Healthwise cover? - ANS-Pregnant women up to 208%
FPL, but there are monthly premiums and copays.
Can inmates be covered under Presumptive Eligibility? - ANS-Yes, but only for inpatient hospital
stays and they must be in a correctional facility and under contract with the FSSA.
Catastrophic Plan - ANS-plans that are exempt for Actuarial Value requirements and the
deductible is close to the out of pocket maximum; this plan qualifies as Minimum Essential
Coverage (MEC) and is not eligible for PTCs or CSRs. to receive this plan, individual must be
under 30 OR they have received an exemption to maintain MEC
cost-sharing - ANS-the share of costs covered out of pocket by an individual through
deductibles, coinsurance, and copayments
Cost-Sharing Reduction (CSR) - ANS-a discount that lowers the amount consumers have to pay
for deductibles, copayments, and coinsurance. this is offered in addition to PTCs, and
individuals do not have to apply separately from PTC if qualified. CSRs increase the Actuarial
Value (AV) of health coverage plans for low-income people/reduces out of pocket costs
Define "community spouse" - ANS-The non-institutionalized spouse of an institutionalized
person that may maintain all of their personal income, and half of the income from assets owned
by both spouses; is this totals less than $2250/mo., the community spouse may keep some of
the institutionalize spouse's income
Define AO - ANS-Application Organization: an entity that must be certified and registered with
the state of Indiana to assist Hoosiers with applications on the FFM and/or for IHCPs
Define CAC - ANS-Certified Application Counselors: individuals (staff members or volunteers)
who fulfill some of the same roles as Navigators and are certified as Indiana Navigators through
the IDOI; they are not responsible for outreach and education but they do provide free
information to consumers about insurance programs and they help to facilitate the enrollment in
health coverage.
define coinsurance - ANS-a bill from an enrollee's healthcare provider for a percentage of the
cost of care after a visit
, Define conflict of loyalty. - ANS-A business or personal interest that keeps the IN Navigator or
AO from acting in the best interest of the consumer that must be reported.
define copayment - ANS-a flat fee paid by enrollee before they can see a healthcare provider
define deductible - ANS-the amount an enrollee has to pay fully out of pocket for healthcare
before insurance will make payments; once met, there may be copays, coinsurance, or they
may pay entire cost
Define direct financial incentive. - ANS-A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a specific/stop-loss
plan. Not allowed (ie agents or brokers)
Define FFM - ANS-Federally-facilitated Marketplace: federally developed and operated
insurance marketplace that makes Qualified Health Providers, Premium Tax Credits, and Cost
Share Reductions available to individuals and/or employers in accordance with the Affordable
Care Act (ACA). Also referred to as www.healthcare.gov or an Exchange.
Define IHCP - ANS-Indiana Health Coverage Program: programs under Indiana Medicaid
developed to address the medical needs of low income, aged, disabled, pregmant and other
populations meeting the different eligibility criteria of each program. www.dfrbenefits.in.gov
Define Indiana Navigator - ANS-an individual certified by the state of Indiana to provide
application assistance through the Federally Facilitated Marketplace (FFM: QHPs, PTCs, CSRs)
and/or the Indiana Health Coverage Program (Medicaid, CHIP, HIP, HHW, Hoosier Care
Connect)
Define indirect financial incentive. - ANS-Conflict of interest: must be disclosed to IDOI and all
consumers prior to assisting with coverage that an AO or Navigator holds stock in an insurance
company and may indirectly benefit if consumer purchases a plan with the assistance of a
Navigator.
Define MAGI - ANS-Modified Adjusted Gross Income (MAGI) is the nationwide standardized
income calculation used in the Federally-facilitated Marketplace (FFM) to determine eligibility for
tax credits and cost sharing, and also in some IHCPs to determine eligibility.
Define Medical Loss Ratio (MLR). - ANS-the percent of premiums collected by an insurance
company that must be spent on medical services and quality improvement; if not met by
insurance company, individuals and small businesses covered will receive a refund
Define Medically Frail through HIP. - ANS-someone who has a severe/debilitating physical
medical condition; a serious mental health issue such as alcohol/substance abuse or major
depression, schizophrenia, bipolar disorder, or PTSD; or needs assistance in the activities of
daily living (eating, moving, dressing, bathing, using toilet) and/or requires 24 hour supervision,
assistance, or monitoring
Define Navigator PE - ANS-Navigator Precertification Education: education and training
programs approved by the IDOI that must be completed by individuals as part of the initial
Indiana Navigator certification application process and prior to taking the Navigator
Examination.
Define no additional financial incentive. - ANS-Conflict of interest that is permissible: an Indiana
Navigator receives an hourly wage from an employer/AO, regardless of number of consumers
helped or plans selected
Define non-MAGI resources and assets. - ANS-Real or personal property or accounts that are
owned solely or jointly by an individual, including cash on hand.
2025/2026
3 month retroactive eligibility does not apply to - ANS-HIP or CHIP
A complaint about an IN Nav can be made to the IDOI and will be processed within - ANS-72
hours
A federally-designated consumer assistant may be which of the following? - ANS-Certified
Application Counselor (CAC), Federal Navigator, or a Producer (Broker and/or Agent)
A pregnant woman does not count the number of children she is expecting when determining
household size for MAGI? - ANS-False- she counts herself plus the number of children she is
expecting
ACA insurance market changes - ANS-1. ensure premiums pay healthcare costs
2. state reviews all premium rate increases
3. premiums based on age, location, tobacco/smoking status, and family status (# of people in
household)
4. guaranteed availability and renewability
5. adult dependent coverage until 26
6. expanded coverage for preventative services (many required to be covered w/out cost
sharing)
7. Essential Health Benefits (EHBs)
8. elimination of lifetime and annual maximum coverage limits for EHB coverage
Actuarial Value (AV) - ANS-indicates the average percentage of plan charges the insurer
expects to pay for ALL enrollees in that plan. the higher the AV, the higher the premium but
lower the cost sharing
Actuarial Value (AV) Statistics by tier - ANS-1. bronze 60%
2. silver 70%
3. gold 80%
4. platinum (not available in IN) 90%
Advanced Premium Tax Credit (APTC) - ANS-credits paid directly to insurance company to
reduce individual's premium costs
After close to 12 months, QHPs will send a re-enrollment notice to consumers stating they will
be automatically re-enrolled in their current plan as long as their info meets eligibility
requirements. - ANS-True- but consumers should evaluate all coverage options in case they
qualify for something that they didn't last time. Information may also need to be updated.
An individual cannot be an Indiana Navigator if: - ANS-1. They have been denied, suspended,
or revoked of an insurance agent/broker license, IN Navigator Certification, or an equivalent
license certification
2. They have been convicted of a disqualifying felony or crime as determined by the
Commissioner of Insurance
,3. They have been convicted of unfair trade practice or fraud in insurance business
4. They have an unpaid state income tax or child support obligation
An unborn child counts toward family size for which programs? - ANS-Presumptive Eligibility
and/or Hoosier Healthwise
Applicants are considered disabled when applying for FFM plans if they receive Social Security
Disability Insurance (SSDI) or Supplemental Security Income (SSI)? - ANS-true
application inconsistency or data matching issue (DMI) occurs when? - ANS-when FFMs cannot
verify electronic information through trusted data sources and applicants have to submit
documentation
Are Native Americans required to pay cost sharing fees when enrolled in HIP? - ANS-No, by
federal rule they are exempt from cost sharing.
Are undocumented individuals eligible for Medicaid coverage? - ANS-Yes and no: they are
eligible for Emergency Services only through their selected program, but they still have to meet
the eligibility requirements for the selected plan (Medicaid)
Batch Auto Re-enrollment (BAR) is... - ANS-the auto re-enrollment process that
marketplace/FFM uses to ensure enrollees continue to have coverage if they do not make an
active plan selection
Besides children, who does Hoosier Healthwise cover? - ANS-Pregnant women up to 208%
FPL, but there are monthly premiums and copays.
Can inmates be covered under Presumptive Eligibility? - ANS-Yes, but only for inpatient hospital
stays and they must be in a correctional facility and under contract with the FSSA.
Catastrophic Plan - ANS-plans that are exempt for Actuarial Value requirements and the
deductible is close to the out of pocket maximum; this plan qualifies as Minimum Essential
Coverage (MEC) and is not eligible for PTCs or CSRs. to receive this plan, individual must be
under 30 OR they have received an exemption to maintain MEC
cost-sharing - ANS-the share of costs covered out of pocket by an individual through
deductibles, coinsurance, and copayments
Cost-Sharing Reduction (CSR) - ANS-a discount that lowers the amount consumers have to pay
for deductibles, copayments, and coinsurance. this is offered in addition to PTCs, and
individuals do not have to apply separately from PTC if qualified. CSRs increase the Actuarial
Value (AV) of health coverage plans for low-income people/reduces out of pocket costs
Define "community spouse" - ANS-The non-institutionalized spouse of an institutionalized
person that may maintain all of their personal income, and half of the income from assets owned
by both spouses; is this totals less than $2250/mo., the community spouse may keep some of
the institutionalize spouse's income
Define AO - ANS-Application Organization: an entity that must be certified and registered with
the state of Indiana to assist Hoosiers with applications on the FFM and/or for IHCPs
Define CAC - ANS-Certified Application Counselors: individuals (staff members or volunteers)
who fulfill some of the same roles as Navigators and are certified as Indiana Navigators through
the IDOI; they are not responsible for outreach and education but they do provide free
information to consumers about insurance programs and they help to facilitate the enrollment in
health coverage.
define coinsurance - ANS-a bill from an enrollee's healthcare provider for a percentage of the
cost of care after a visit
, Define conflict of loyalty. - ANS-A business or personal interest that keeps the IN Navigator or
AO from acting in the best interest of the consumer that must be reported.
define copayment - ANS-a flat fee paid by enrollee before they can see a healthcare provider
define deductible - ANS-the amount an enrollee has to pay fully out of pocket for healthcare
before insurance will make payments; once met, there may be copays, coinsurance, or they
may pay entire cost
Define direct financial incentive. - ANS-A conflict of interest: an individual receives
compensation from a health insurance company for enrolling a consumer in a specific/stop-loss
plan. Not allowed (ie agents or brokers)
Define FFM - ANS-Federally-facilitated Marketplace: federally developed and operated
insurance marketplace that makes Qualified Health Providers, Premium Tax Credits, and Cost
Share Reductions available to individuals and/or employers in accordance with the Affordable
Care Act (ACA). Also referred to as www.healthcare.gov or an Exchange.
Define IHCP - ANS-Indiana Health Coverage Program: programs under Indiana Medicaid
developed to address the medical needs of low income, aged, disabled, pregmant and other
populations meeting the different eligibility criteria of each program. www.dfrbenefits.in.gov
Define Indiana Navigator - ANS-an individual certified by the state of Indiana to provide
application assistance through the Federally Facilitated Marketplace (FFM: QHPs, PTCs, CSRs)
and/or the Indiana Health Coverage Program (Medicaid, CHIP, HIP, HHW, Hoosier Care
Connect)
Define indirect financial incentive. - ANS-Conflict of interest: must be disclosed to IDOI and all
consumers prior to assisting with coverage that an AO or Navigator holds stock in an insurance
company and may indirectly benefit if consumer purchases a plan with the assistance of a
Navigator.
Define MAGI - ANS-Modified Adjusted Gross Income (MAGI) is the nationwide standardized
income calculation used in the Federally-facilitated Marketplace (FFM) to determine eligibility for
tax credits and cost sharing, and also in some IHCPs to determine eligibility.
Define Medical Loss Ratio (MLR). - ANS-the percent of premiums collected by an insurance
company that must be spent on medical services and quality improvement; if not met by
insurance company, individuals and small businesses covered will receive a refund
Define Medically Frail through HIP. - ANS-someone who has a severe/debilitating physical
medical condition; a serious mental health issue such as alcohol/substance abuse or major
depression, schizophrenia, bipolar disorder, or PTSD; or needs assistance in the activities of
daily living (eating, moving, dressing, bathing, using toilet) and/or requires 24 hour supervision,
assistance, or monitoring
Define Navigator PE - ANS-Navigator Precertification Education: education and training
programs approved by the IDOI that must be completed by individuals as part of the initial
Indiana Navigator certification application process and prior to taking the Navigator
Examination.
Define no additional financial incentive. - ANS-Conflict of interest that is permissible: an Indiana
Navigator receives an hourly wage from an employer/AO, regardless of number of consumers
helped or plans selected
Define non-MAGI resources and assets. - ANS-Real or personal property or accounts that are
owned solely or jointly by an individual, including cash on hand.
