State RegulationsTX specificDifficulty 2/5
A Texas client with a modest household income asks her agent whether she can receive a premium tax credit if she buys the same plan directly from the insurer instead of through the Marketplace. The correct answer is:
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under ACA Section 1321, financial assistance is tied to enrollment through the Exchange: an eligible individual who enrolls in a Qualified Health Plan through the Marketplace may receive advance payments of the premium tax credit, while the same benefit design purchased off-Marketplace does not carry the credit. A state filing by the insurer is irrelevant to that federal linkage, and Medicare entitlement is not the test, since entitlement to Medicare generally makes a person ineligible for the credit rather than eligible for it.
Why the other options are wrong
- B) A state form filing has no bearing on whether federal financial assistance is payable.
- C) Medicare entitlement is the opposite of the test; it generally disqualifies a person from the premium tax credit.
- D) The credit is tied to the enrollment channel, not to the plan design, so it does not follow the plan off-Marketplace.
Memory hook
No Exchange enrollment, no subsidy.