State RegulationsTX specificDifficulty 2/5
Which of the following activities is performed by the insurance company offering a qualified health plan rather than by the Marketplace?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under ACA Section 1321, the Marketplace serves as the platform that certifies qualified health plans, determines eligibility to enroll and eligibility for financial assistance, and facilitates enrollment. It is not the insurer. Premium rates for a qualified health plan are developed, filed, and charged by the issuing insurance company, subject to state rate review. A Texas agent should therefore direct premium and billing questions to the issuer, not to the Marketplace.
Why the other options are wrong
- B) Eligibility to enroll through the Marketplace is determined by the Marketplace, not by the insurer.
- C) Certification of qualified health plans is a Marketplace function under ACA Section 1321.
- D) Eligibility for advance payments of the premium tax credit is determined by the Marketplace as part of the eligibility determination process.
Memory hook
The Marketplace runs the store; the issuer sets the price.