1
PY
PY 2024 INDIVIDUAL MARKETPLACE
TRAINING FOR NEW AGENTS AND
BROKERS EXAM QUESTIONS WITH
CORRECT VERIFIED SOLUTIONS 100%
GUARANTEED PASS
What is the MLR - (Medical Loss Ratio) - ANS ✓The ACA limits the proportion
of premiums that a health insurance issuer can spend on things other than
medical claims and improving the quality of the healthcare of its enrollees. MLR
is a basic financial measurement that generally shows how much of the premium
dollars a health insurance issuer spends on healthcare expenses, as opposed to
profits or administrative costs. A health insurance issuer that does not spend
enough of its premium dollars on healthcare services or quality improvement
activities must provide rebates to individuals and employers.
Review Question: Last December, you helped Amari enroll in Marketplace
coverage. It's now OE again, and Amari tells you he's worried he won't be
able to sign up for the same plan again because he had cancer this year and
had high utilization of his policy. You tell Amari he doesn't need to worry,
because Marketplace plans don't take your healthcare spending or health
status into consideration when considering eligibility. What is this policy
called?
Guaranteed issue
Guaranteed renewability
Grandfathered plan - ANS ✓Guaranteed Renewability
What are the functions of the Marketplace? - ANS ✓Certifying health plans to
participate in the Marketplace as QHPs*
PY 2024
, 2
PY
Determining or assessing individuals' eligibility for enrollment in Medicaid
or CHIP
Carrying out certain plan oversight functions, including monitoring QHP
issuers for continuing compliance with certification requirements
Determining individuals' eligibility for enrollment in a QHP through the
Marketplace
Determining individuals' eligibility for APTC and CSRs
Facilitating individuals' enrollment in a QHP
Who does HHS rely on to certify QHPs to meet the Marketplace certification
standards in certain areas? - ANS ✓States
What is CMS - ANS ✓Centers for Medicare and Medicaid Services
It is a federal agency that runs the FFM, Medicare, Medicaid, and CHIP. For
more information, visit CMS.gov. You will learn more about the role of CMS
as it relates to Marketplace-registered agents and brokers in the
Maintaining Compliance module.
What are Agent/Broker Roles in the Marketplace? - ANS ✓Agents and
brokers can assist individuals with enrollment in QHPs through the Individual
Marketplace, as well as assist small employers with selecting and enrolling in
SHOP coverage.
Agents and brokers may also assist qualified individuals with obtaining
eligibility determinations for financial assistance through the Marketplace.
If consumers are potentially eligible for Medicaid or CHIP, Marketplace-
registered agents and brokers can help these consumers connect with the
appropriate state agency to apply for this coverage.
PY 2024
, 3
PY
Who can assist individuals on the marketplace besides Brokers - ANS
✓CAC's
Navigators
EAPS - limited contract
What are Navigators? - ANS ✓Organizations that are approved by and receive
grants from CMS have certified Navigators who, among other required duties,
must assist consumers in applying for and enrolling in health coverage through
the Marketplace free of charge
What are CACs? - ANS ✓community health centers, healthcare providers, and
certain social service agencies. Marketplace CACs are certified directly by those
CDOs. Participation as a CDO is voluntary and not funded by the Marketplace.
What are EAPs? - ANS ✓Under a 19-month contract with CMS, EAPs employed
with Cognosante will assist with the "Medicaid unwinding" efforts. They will
provide outreach and impartial, free, in-person and virtual enrollment assistance
to impacted consumers in specific counties within 12 FFM states: AZ, FL, IL, LA,
MI, MT, NC, OK, SD, TN, TX and UT. EAPs will also collaborate with CACs in other
FFM states to maximize outreach opportunities
Navigators and CACs may not receive compensation directly or indirectly
from any health insurance issuer or issuer of stop-loss insurance in
connection with the enrollment of any individuals or employees in a QHP or
non-QHP. True or False - ANS ✓TRUE
Assisters in the Marketplace can make specific plan recommendations to
consumers. True or False - ANS ✓FALSE
If unable to assist a consumer with, for example, applying for Medicaid
through a Marketplace, the agent or broker should make sure the
consumer knows that local Navigators and CACs may be available to
provide assistance. They may also help direct the consumer to the
appropriate state Medicaid agency, if applicable. True or False - ANS ✓TRUE
PY 2024
PY
PY 2024 INDIVIDUAL MARKETPLACE
TRAINING FOR NEW AGENTS AND
BROKERS EXAM QUESTIONS WITH
CORRECT VERIFIED SOLUTIONS 100%
GUARANTEED PASS
What is the MLR - (Medical Loss Ratio) - ANS ✓The ACA limits the proportion
of premiums that a health insurance issuer can spend on things other than
medical claims and improving the quality of the healthcare of its enrollees. MLR
is a basic financial measurement that generally shows how much of the premium
dollars a health insurance issuer spends on healthcare expenses, as opposed to
profits or administrative costs. A health insurance issuer that does not spend
enough of its premium dollars on healthcare services or quality improvement
activities must provide rebates to individuals and employers.
Review Question: Last December, you helped Amari enroll in Marketplace
coverage. It's now OE again, and Amari tells you he's worried he won't be
able to sign up for the same plan again because he had cancer this year and
had high utilization of his policy. You tell Amari he doesn't need to worry,
because Marketplace plans don't take your healthcare spending or health
status into consideration when considering eligibility. What is this policy
called?
Guaranteed issue
Guaranteed renewability
Grandfathered plan - ANS ✓Guaranteed Renewability
What are the functions of the Marketplace? - ANS ✓Certifying health plans to
participate in the Marketplace as QHPs*
PY 2024
, 2
PY
Determining or assessing individuals' eligibility for enrollment in Medicaid
or CHIP
Carrying out certain plan oversight functions, including monitoring QHP
issuers for continuing compliance with certification requirements
Determining individuals' eligibility for enrollment in a QHP through the
Marketplace
Determining individuals' eligibility for APTC and CSRs
Facilitating individuals' enrollment in a QHP
Who does HHS rely on to certify QHPs to meet the Marketplace certification
standards in certain areas? - ANS ✓States
What is CMS - ANS ✓Centers for Medicare and Medicaid Services
It is a federal agency that runs the FFM, Medicare, Medicaid, and CHIP. For
more information, visit CMS.gov. You will learn more about the role of CMS
as it relates to Marketplace-registered agents and brokers in the
Maintaining Compliance module.
What are Agent/Broker Roles in the Marketplace? - ANS ✓Agents and
brokers can assist individuals with enrollment in QHPs through the Individual
Marketplace, as well as assist small employers with selecting and enrolling in
SHOP coverage.
Agents and brokers may also assist qualified individuals with obtaining
eligibility determinations for financial assistance through the Marketplace.
If consumers are potentially eligible for Medicaid or CHIP, Marketplace-
registered agents and brokers can help these consumers connect with the
appropriate state agency to apply for this coverage.
PY 2024
, 3
PY
Who can assist individuals on the marketplace besides Brokers - ANS
✓CAC's
Navigators
EAPS - limited contract
What are Navigators? - ANS ✓Organizations that are approved by and receive
grants from CMS have certified Navigators who, among other required duties,
must assist consumers in applying for and enrolling in health coverage through
the Marketplace free of charge
What are CACs? - ANS ✓community health centers, healthcare providers, and
certain social service agencies. Marketplace CACs are certified directly by those
CDOs. Participation as a CDO is voluntary and not funded by the Marketplace.
What are EAPs? - ANS ✓Under a 19-month contract with CMS, EAPs employed
with Cognosante will assist with the "Medicaid unwinding" efforts. They will
provide outreach and impartial, free, in-person and virtual enrollment assistance
to impacted consumers in specific counties within 12 FFM states: AZ, FL, IL, LA,
MI, MT, NC, OK, SD, TN, TX and UT. EAPs will also collaborate with CACs in other
FFM states to maximize outreach opportunities
Navigators and CACs may not receive compensation directly or indirectly
from any health insurance issuer or issuer of stop-loss insurance in
connection with the enrollment of any individuals or employees in a QHP or
non-QHP. True or False - ANS ✓TRUE
Assisters in the Marketplace can make specific plan recommendations to
consumers. True or False - ANS ✓FALSE
If unable to assist a consumer with, for example, applying for Medicaid
through a Marketplace, the agent or broker should make sure the
consumer knows that local Navigators and CACs may be available to
provide assistance. They may also help direct the consumer to the
appropriate state Medicaid agency, if applicable. True or False - ANS ✓TRUE
PY 2024
