Triggering Event
Eligibility
Affordable Care Act
Abbreviations
Medi-cal
100
If you quit your job and lose health coverage from your employer, is that considered a qualified life event?
Yes, even though you voluntarily quit your job your coverage loss is not considered voluntary.
100
Must you be a US citizen to qualify for Financial Assistance
Yes
100
What year did ACA plan take effect?
ACA plans took effect in 2014
100
What does FFM stand for?
Federally Facilitated Marketplace
100
Does Medi-Cal provide a core set of health benefits know as "essential health benefits?"
Medi-Cal provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures that all Medi-Cal health plans offer what is known as “essential health benefits."
200
You are a member of a federally recognized American Indian tribe, can you enroll at any time and change plans once per month?
Yes, If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.
200
At what percent is an employer plan considered Affordable allowing you to be eligible for Financial Assistance
9.5%
200
What is the "shared responsibility payment"?
The “shared responsibility payment” is a new tax penalty that Americans have to pay this year if they can afford health insurance but choose not to buy it.
200
What does APTC stand for
Advanced Premium Tax Credit
200
Do you need to have a qualifying life event and be in a Special Enrollment period to enroll into Medi-cal?
No, Medi-cal accepts eligible prospect all year long
300
You currently have COBRA coverage and you no longer can afford to pay for it and your coverage ends due to non-payment. Do you qualify to enroll during a Special Enrollment Period from the loss of coverage?
No, if your coverage end due to non-payment that is not qualified life event starting a Special Enrollment Period.
300
If you exceed 400% of the FPL can you enroll through CoveredCA
Yes, but you would not be getting assistance.
300
When did the previous Open enrollment period end?
January 31st 2016
300
What does FPL stand for?
Federal Poverty Level
300
If you're no longer eligible for Medi-Cal and they cancel your coverage, is that a qualified life event?
Yes. You would not qualify if the coverage was voluntarily cancelled by the member however.
400
If you're not covered and reside in Florida and permanently relocate to California, is that a qualified life event allowing you to enroll
No, with CoveredCA and Permanently Relocation you must have coverage at least 1 day in the 60 days prior to the move.
400
Must you have filed taxes for the previous year in order to receive the APTC
No, you must confirm they will file taxes for the benefit year.
400
What is the Tax Penalty for the 2016 plan year?
2016 may be subject to the penalty, which is $695 per person in a household or 2.5 percent of their income, whichever is greater.
400
What does AI/AN stand for?
American Indian/ Native Alaskan
400
If you are not a lawfully present individual can you apply through Medi-Cal?
Yes, Immigrants who are not lawfully present are not eligible to purchase a health plan through Covered California; however, they may be eligible for coverage through Medi-Cal.
500
If your employer coverage ended on July 31st 2016 and you submit an application through CoveredCA on August 20th what is the effective date for coverage.
September 1st, 2016 with CoveredCA the effective date will be the first of the following month.
500
When determining taxable household size and income for financial assistance, if a child earns enough money to file a tax return for themselves, are you to include them?
Yes, The Marketplace counts income for each of these people and considers them part of your household depending on things like their age and relationship to you, the type and amount of income they have, and more.
500
Rehabilitative and habilitative services are part of the 10 Essential Health Benefits. True or False
True, The Affordable Care Act requires that all health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits.
500
What does CEC and PBE stand for?
Certified Enrollment Counselor and Plan Based Enroller
500
If a women is pregnant does she qualify for Medi-cal?
In some situations there are programs available to assist pregnant woman but it depends on other factors such as income level and citizenship or immigration status.
M
e
n
u