ACA Essential Health Benefits & Plan Types 2

Question 1

Which of the following is an Essential Health Benefit mandated by the ACA?

Accepted Answer

Prescription drug coverage

Answer

Prescription drugs are one of the 10 mandated EHBs; alternative medicine, long-term care, and adult vision care are not required EHBs.

Question 2

What does an HMO (Health Maintenance Organization) typically require of its members?

Accepted Answer

Choosing a primary care physician and obtaining referrals for specialists

Answer

HMOs require members to select a primary care physician (PCP) who coordinates care and must provide referrals for specialist visits to be covered.

Question 3

What best describes an Exclusive Provider Organization (EPO)?

Accepted Answer

A plan that only covers in-network care except in emergencies

Answer

EPOs restrict coverage to in-network providers except for emergency care, but unlike HMOs, they typically do not require specialist referrals.

Question 4

What does 'actuarial value' represent in an ACA health plan?

Accepted Answer

The percentage of total covered healthcare costs the plan pays on average

Answer

Actuarial value is the percentage of total covered healthcare expenses that the plan pays for a standard population of enrollees.

Question 5

Which plan type typically offers the MOST provider flexibility but usually has higher monthly premiums?

Accepted Answer

PPO

Answer

PPOs allow members to see any provider, including out-of-network providers, without a referral, offering the most flexibility at typically higher premium costs.

(ACA) Affordable Care Act Certified Practice Test

(ACA) Affordable Care Act Certified Practice Test

ACA Essential Health Benefits & Plan Types 2