State RegulationsNY specificDifficulty 2/5
A self-employed Rochester resident with a serious chronic illness asks a licensed New York agent whether she can buy individual coverage through the exchange. Under the Affordable Care Act, what is the correct advice?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under the Affordable Care Act, eligibility to buy individual coverage through the exchange turns on factors such as residence in the exchange's service area and lawful presence in the United States - never on health status. Because health-status underwriting is prohibited, her chronic illness is irrelevant to her eligibility and no insurer may refuse her. New York's exchange applies the same guaranteed-issue principle to its enrollees.
Why the other options are wrong
- A) Health status cannot bar exchange enrollment; the Affordable Care Act forbids health-based eligibility rules.
- C) There is no treatment-triggered window; exchange enrollment is not tied to an illness episode.
- D) No prior employer coverage is required; individuals may buy exchange coverage on their own.
Memory hook
Exchange eligibility asks where you live - never how healthy you are.