Indiana Navigator State Certification
Comprehensive Exam 2025/2026Prep by IDOI
Standards – Pass on Your First Attempt and
Avoid Resit
Federal Navigator Producer (Broker and/or Agent) -
ANSWER//Certified Application Counselor (CAC) True or
False: A pregnant woman does not count the number of
children she is expecting when determining household
size for MAGI? - ANSWER//False What indicates the
average percentage of plan charges the insurer expects to
pay for ALL enrollees in that plan? The higher the AV, the
higher the premium but lower the cost sharing. -
ANSWER//Actuarial Value (AV) What are the Actuarial
Value (AV) statistics by tier? A. Bronze 60% Silver 70%
Gold 80% Platinum 90% (not available in Indiana) B.
Platinum 90% (not available in Indiana) Silver 70% Gold
80% Bronze 60% - ANSWER//A. In the Actuarial Value
statistics by tier, are Platinum 90% available in Indiana? -
ANSWER//No What is Advanced Premium Tax Credit
(APTC)? - ANSWER//Credits paid directly to insurance
company to reduce individual's premium costs. True or
False: After close to 12 months, QHPs will send a re-
enrollment notice to consumers stating they will be
automatically re-enrolled in their current plan as long as
their information meets eligibility requrements. -
ANSWER//True Can an individual be an Indiana Navigator
if they have been denied, suspended, or revoked of an
insurance agent/broker license, IN Navigator Certification,
or an equivalent license certification? - ANSWER//No Can
an individual be an IN Navigator if they have been
convicted of a disqualifying felony or crime as determined
by the Commissioner of Insurance? - ANSWER//No Can
an individual be an IN Navigator if they have been
convicted of unfair trade practice or fraud in the insurance
business? - ANSWER//No Can an individual be an IN
,Navigator if they have an unpaid state income tax or child
support obligation? - ANSWER//No An unborn child
counts toward family size for which two programs? -
ANSWER//Presumptive Eligibility OR Hoosier Healthwise
True or False: Applicants are considered disabled when
applying for FFM plans if they received Social Security
Disability Insurance (SSDI) or Supplemental Security
Income (SSI)? - ANSWER//True When does application
inconsistency or data matching issue (DMI) occur? -
ANSWER//When FFMs cannot verify electronic
information through trusted data sources and applicants
have to submit documentation. Are Native Americans
required to pay cost sharing fees when enrolled in HIP? -
ANSWER//No, by federal rule they are exempt from cost
sharing. Are undocumented individuals eligible for
Medicaid coverage? - ANSWER//Yes and no; They are
eligible for Emergency Services only through their
selected program, but they still have to meet the eligibility
requirements for that selected plan (Medicaid). What is
Batch Auto Re-enrollment (BAR)? - ANSWER//The auto
re-enrollment process that marketplace / FFM uses to
ensure enrollees continue to have coverage if they do not
make an active plan selection. Besides children, who does
Hoosier Healthwise cover? - ANSWER//Pregnant women
up to 208% FPL, but there are monthly premiums and
copays. Can inmates be covered under Presumptive
Eligibility (PE)? - ANSWER//Yes, but only for inpatient
hospital stays and they must be in a correctional facility
and under contract with the FSSA. What are Catastrophic
Plans? - ANSWER//They are plans that are exempt for
Actuarial Value requirements and the deductible is close
to the out of pocket maximum. What plan qualifies as
minimum essentials coverage (MEC) and is not eligible for
PTCs or CSRs? - ANSWER//Catastrophic Plan What plan
must an individual be under 30 OR they have received an
exemption to maintain MEC to receive benefits? -
ANSWER//Catastrophic Plan What is cost-sharing? -
,ANSWER//The share of costs covered out of pocket by an
individual through deductibles, coinsurance, and
copayments. What is cost-sharing reduction (CSR)? -
ANSWER//A discount that lowers the amount consumers
have to pay for deductibles, copayments, and coinsurance.
What is offered in addition to PTCs, and individuals do not
have to apply separately from PTC, if qualified? -
ANSWER//Cost-Sharing reduction CSRs increase the
_______________ of health coverage plans for low-
income people/reduces out of pocket costs. -
ANSWER//Actuarial Value (AV) What is the non-
institutionalized spouse of an institutionalized person that
may maintain all of their personal income, and half of the
income from assets owned by both spouses; is this totals
less than $2250/month., the community spouse may keep
some of the institutionalize spouse's income? -
ANSWER//Community Spouse Define Application
Organization (AO). - ANSWER//An entity that must be
certified and registered with the state of Indiana to assist
Hoosiers with applications on the FFM and/or for IHCPs.
Define Certified Application Counselors (CAC). -
ANSWER//Individuals who fulfill some of the same roles
as Navigators and are certified as IN Navigators through
the IDOI; they are not responsible for outreach and
education but they do provide free information to
consumers about insurance programs and they help to
facilitate the enrollment in health coverage. Define
coinsurance. - ANSWER//A bill from an enrollee's
healthcare provider for a percentage of the cost of care
after a visit. What is a business or personal interest that
keeps the IN Navigator or AO from acting in the best
interest of the consumer that must be reported? -
ANSWER//Conflict of Loyalty What is a flat fee paid by
enrollee before they can see a healthcare provider? -
ANSWER//Copayment What is the amount an enrollee
has to pay fully out of pocket for healthcare before
insurance will make payments; once met, there may be
, copays, coinsurance, or they may pay entire cost? -
ANSWER//Deductible Define direct financial incentive. -
ANSWER//A conflict of interest: an individual receives
compensation from a health insurance company for
enrolling a consumer in a specific/stop-loss plan. Not
allowed (ie agents or brokers) What is a federally
developed and operated insurance marketplace that
makes Qualified Health Providers, Premium Tax Credits,
and Cost Share Reductions available to individuals and/or
employers in accordance with the Affordable Care Act
(ACA)? Also referred to as www.healthcare.gov or an
Exchange. - ANSWER//Federally-facilitated Marketplace
(FFM) What are programs under Indiana Medicaid
developed to address the medical needs of low income,
aged, disabled, pregnant and other populations meeting
the different eligibility criteria of each program? -
ANSWER//Indiana Health Coverage Program (IHCP)
What is an individual certified by the state of Indiana to
provide application assistance through the Federally-
Facilitated Marketplace (FFM: QHPs. PTCs, CSRs) and/or
the Indiana Health Coverage Program (Medicaid, CHIP,
HIP, HHW, Hoosier Care Connect)? - ANSWER//Indiana
Navigator Define indirect financial incentive. -
ANSWER//Conflict of interest: must be disclosed to IDOI
and all consumers prior to assisting with coverage that an
AO or Navigator holds stock in an insurance company and
may indirectly benefit if consumer purchases a plan with
the assistance of a Navigator. What does MAGI stand for?
- ANSWER//Modified Adjusted Gross Income What is the
nationwide standardized income calculation used in the
Federally-facilitated Marketplace (FFM) to determine
eligibility for tax credits and cost sharing, and also in some
IHCPs to determine eligibility? - ANSWER//Modified
Adjusted Gross Income (MAGI) What is the percent of
premiums collected by an insurance company that must
be spend on medical services and quality improvement; if
not met by insurance company, individuals and small
Comprehensive Exam 2025/2026Prep by IDOI
Standards – Pass on Your First Attempt and
Avoid Resit
Federal Navigator Producer (Broker and/or Agent) -
ANSWER//Certified Application Counselor (CAC) True or
False: A pregnant woman does not count the number of
children she is expecting when determining household
size for MAGI? - ANSWER//False What indicates the
average percentage of plan charges the insurer expects to
pay for ALL enrollees in that plan? The higher the AV, the
higher the premium but lower the cost sharing. -
ANSWER//Actuarial Value (AV) What are the Actuarial
Value (AV) statistics by tier? A. Bronze 60% Silver 70%
Gold 80% Platinum 90% (not available in Indiana) B.
Platinum 90% (not available in Indiana) Silver 70% Gold
80% Bronze 60% - ANSWER//A. In the Actuarial Value
statistics by tier, are Platinum 90% available in Indiana? -
ANSWER//No What is Advanced Premium Tax Credit
(APTC)? - ANSWER//Credits paid directly to insurance
company to reduce individual's premium costs. True or
False: After close to 12 months, QHPs will send a re-
enrollment notice to consumers stating they will be
automatically re-enrolled in their current plan as long as
their information meets eligibility requrements. -
ANSWER//True Can an individual be an Indiana Navigator
if they have been denied, suspended, or revoked of an
insurance agent/broker license, IN Navigator Certification,
or an equivalent license certification? - ANSWER//No Can
an individual be an IN Navigator if they have been
convicted of a disqualifying felony or crime as determined
by the Commissioner of Insurance? - ANSWER//No Can
an individual be an IN Navigator if they have been
convicted of unfair trade practice or fraud in the insurance
business? - ANSWER//No Can an individual be an IN
,Navigator if they have an unpaid state income tax or child
support obligation? - ANSWER//No An unborn child
counts toward family size for which two programs? -
ANSWER//Presumptive Eligibility OR Hoosier Healthwise
True or False: Applicants are considered disabled when
applying for FFM plans if they received Social Security
Disability Insurance (SSDI) or Supplemental Security
Income (SSI)? - ANSWER//True When does application
inconsistency or data matching issue (DMI) occur? -
ANSWER//When FFMs cannot verify electronic
information through trusted data sources and applicants
have to submit documentation. Are Native Americans
required to pay cost sharing fees when enrolled in HIP? -
ANSWER//No, by federal rule they are exempt from cost
sharing. Are undocumented individuals eligible for
Medicaid coverage? - ANSWER//Yes and no; They are
eligible for Emergency Services only through their
selected program, but they still have to meet the eligibility
requirements for that selected plan (Medicaid). What is
Batch Auto Re-enrollment (BAR)? - ANSWER//The auto
re-enrollment process that marketplace / FFM uses to
ensure enrollees continue to have coverage if they do not
make an active plan selection. Besides children, who does
Hoosier Healthwise cover? - ANSWER//Pregnant women
up to 208% FPL, but there are monthly premiums and
copays. Can inmates be covered under Presumptive
Eligibility (PE)? - ANSWER//Yes, but only for inpatient
hospital stays and they must be in a correctional facility
and under contract with the FSSA. What are Catastrophic
Plans? - ANSWER//They are plans that are exempt for
Actuarial Value requirements and the deductible is close
to the out of pocket maximum. What plan qualifies as
minimum essentials coverage (MEC) and is not eligible for
PTCs or CSRs? - ANSWER//Catastrophic Plan What plan
must an individual be under 30 OR they have received an
exemption to maintain MEC to receive benefits? -
ANSWER//Catastrophic Plan What is cost-sharing? -
,ANSWER//The share of costs covered out of pocket by an
individual through deductibles, coinsurance, and
copayments. What is cost-sharing reduction (CSR)? -
ANSWER//A discount that lowers the amount consumers
have to pay for deductibles, copayments, and coinsurance.
What is offered in addition to PTCs, and individuals do not
have to apply separately from PTC, if qualified? -
ANSWER//Cost-Sharing reduction CSRs increase the
_______________ of health coverage plans for low-
income people/reduces out of pocket costs. -
ANSWER//Actuarial Value (AV) What is the non-
institutionalized spouse of an institutionalized person that
may maintain all of their personal income, and half of the
income from assets owned by both spouses; is this totals
less than $2250/month., the community spouse may keep
some of the institutionalize spouse's income? -
ANSWER//Community Spouse Define Application
Organization (AO). - ANSWER//An entity that must be
certified and registered with the state of Indiana to assist
Hoosiers with applications on the FFM and/or for IHCPs.
Define Certified Application Counselors (CAC). -
ANSWER//Individuals who fulfill some of the same roles
as Navigators and are certified as IN Navigators through
the IDOI; they are not responsible for outreach and
education but they do provide free information to
consumers about insurance programs and they help to
facilitate the enrollment in health coverage. Define
coinsurance. - ANSWER//A bill from an enrollee's
healthcare provider for a percentage of the cost of care
after a visit. What is a business or personal interest that
keeps the IN Navigator or AO from acting in the best
interest of the consumer that must be reported? -
ANSWER//Conflict of Loyalty What is a flat fee paid by
enrollee before they can see a healthcare provider? -
ANSWER//Copayment What is the amount an enrollee
has to pay fully out of pocket for healthcare before
insurance will make payments; once met, there may be
, copays, coinsurance, or they may pay entire cost? -
ANSWER//Deductible Define direct financial incentive. -
ANSWER//A conflict of interest: an individual receives
compensation from a health insurance company for
enrolling a consumer in a specific/stop-loss plan. Not
allowed (ie agents or brokers) What is a federally
developed and operated insurance marketplace that
makes Qualified Health Providers, Premium Tax Credits,
and Cost Share Reductions available to individuals and/or
employers in accordance with the Affordable Care Act
(ACA)? Also referred to as www.healthcare.gov or an
Exchange. - ANSWER//Federally-facilitated Marketplace
(FFM) What are programs under Indiana Medicaid
developed to address the medical needs of low income,
aged, disabled, pregnant and other populations meeting
the different eligibility criteria of each program? -
ANSWER//Indiana Health Coverage Program (IHCP)
What is an individual certified by the state of Indiana to
provide application assistance through the Federally-
Facilitated Marketplace (FFM: QHPs. PTCs, CSRs) and/or
the Indiana Health Coverage Program (Medicaid, CHIP,
HIP, HHW, Hoosier Care Connect)? - ANSWER//Indiana
Navigator Define indirect financial incentive. -
ANSWER//Conflict of interest: must be disclosed to IDOI
and all consumers prior to assisting with coverage that an
AO or Navigator holds stock in an insurance company and
may indirectly benefit if consumer purchases a plan with
the assistance of a Navigator. What does MAGI stand for?
- ANSWER//Modified Adjusted Gross Income What is the
nationwide standardized income calculation used in the
Federally-facilitated Marketplace (FFM) to determine
eligibility for tax credits and cost sharing, and also in some
IHCPs to determine eligibility? - ANSWER//Modified
Adjusted Gross Income (MAGI) What is the percent of
premiums collected by an insurance company that must
be spend on medical services and quality improvement; if
not met by insurance company, individuals and small
