Which entity can provide an eligibility determination to the consumer during enrollment?

Which entity can provide an eligibility determination to the consumer during enrollment?

• A. The Marketplace
• B. EDE
• C. Classic DE
• D. HealthCare.gov

Answer: (B)

Eligibility determinations during enrollment are provided by the Eligibility Determination Engine (EDE). This automated engine checks the consumer’s data in real time—income, household size, residency, and other eligibility factors—to determine if they qualify for subsidies (like APTC or CSR) or for Medicaid/CHIP. The EDE then returns an eligibility decision within the enrollment flow, so the consumer can see subsidy amounts and plan options immediately. While the Marketplace facilitates enrollment and displays results, the actual calculation and verdict come from the EDE. Other options such as HealthCare.gov or older/deprecated systems do not perform the real-time eligibility determination.

Eligibility determinations during enrollment are provided by the Eligibility Determination Engine (EDE). This automated engine checks the consumer’s data in real time—income, household size, residency, and other eligibility factors—to determine if they qualify for subsidies (like APTC or CSR) or for Medicaid/CHIP. The EDE then returns an eligibility decision within the enrollment flow, so the consumer can see subsidy amounts and plan options immediately. While the Marketplace facilitates enrollment and displays results, the actual calculation and verdict come from the EDE. Other options such as HealthCare.gov or older/deprecated systems do not perform the real-time eligibility determination.