Affordable Care Act (ACA) Marketplace Certification (FFM) — Questions and Answers

Question 1: What is the most common mistake professionals make when implementing policies & regulations strategies?

Developing contingency plans for high-probability risk scenarios (Correct answer)
Responding to problems only after they occur
Creating contingency plans for every possible scenario regardless of probability
Transferring all risk to external partners through contracts

Correct answer: Developing contingency plans for high-probability risk scenarios

Developing contingency plans for high-probability risk scenarios is the correct approach because effective policies & regulations in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Question 2: Which ACA provision was designed specifically to protect insurers from unexpectedly high claims in the first years of marketplace operation through a shared losses mechanism?

Medical Loss Ratio rebates
Risk Corridors (Correct answer)
Risk Adjustment
Reinsurance

Correct answer: Risk Corridors

Risk corridors limited insurer losses by requiring HHS to cover a portion of losses exceeding a set threshold and collecting gains above another threshold.

Question 3: A health plan's Medical Loss Ratio (MLR) report must be submitted to CMS by what deadline each year?

June 1 following the end of the calendar year (Correct answer)
March 31 following the end of the calendar year
September 30 of the following year
December 31 of the reporting year

Correct answer: June 1 following the end of the calendar year

Issuers must submit annual MLR reports to CMS by June 1 following the end of the MLR reporting year.

Question 4: What is a key requirement for employers under the ACA?

Large employers must offer health insurance to full-time employees (Correct answer)
Small businesses must provide coverage to all employees
There are no employer requirements under the ACA
Employers can only offer coverage to part-time workers

Correct answer: Large employers must offer health insurance to full-time employees

The ACA’s Employer Mandate requires large employers to provide health insurance to full-time employees or face penalties.

Question 5: In the context of affordable care act certified, which principle most directly governs policies & regulations practices?

Following popular trends without evaluating their applicability
Relying exclusively on vendor-provided solutions
Using trial-and-error without systematic documentation
Applying evidence-based methodologies with peer-reviewed support (Correct answer)

Correct answer: Applying evidence-based methodologies with peer-reviewed support

Applying evidence-based methodologies with peer-reviewed support is the correct approach because effective policies & regulations in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Question 6: Which of the following best reflects the ethical standard of 'accountability' for ACA enrollment assisters?

Taking responsibility for the accuracy of assistance provided and being transparent about errors or limitations (Correct answer)
Completing enrollment quotas set by the organization
Reporting client outcomes to the insurer for quality tracking
Maintaining a high client satisfaction rating on surveys

Correct answer: Taking responsibility for the accuracy of assistance provided and being transparent about errors or limitations

Accountability means owning the quality of assistance provided, being honest about mistakes, and continuously improving to serve clients accurately.

Question 7: A stakeholder questions the value of professional ethics & standards initiatives. Which response best demonstrates ROI?

Avoiding accountability discussions to prevent conflict
Centralizing accountability with a single individual
Distributing accountability so widely that no one is responsible
Building a culture of accountability with transparent reporting (Correct answer)

Correct answer: Building a culture of accountability with transparent reporting

Building a culture of accountability with transparent reporting is the correct approach because effective professional ethics & standards in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Question 8: Under the ACA, which federal agency oversees Medicaid program administration and expansion implementation?

The Department of Labor (DOL)
The Internal Revenue Service (IRS)
The Centers for Medicare & Medicaid Services (CMS) (Correct answer)
The Department of Health and Human Services Office of Civil Rights

Correct answer: The Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) within HHS administers Medicaid at the federal level and oversees state implementation of ACA expansion.

Question 9: Under the ACA, what is the federal government's matching rate (FMAP) for newly eligible Medicaid expansion enrollees?

50% federal match
75% federal match
100% federal match through 2020, then 90% (Correct answer)
90% federal match

Correct answer: 100% federal match through 2020, then 90%

The federal government paid 100% of Medicaid expansion costs through 2016, phasing down to a permanent 90% federal match starting in 2020.

Question 10: What was the Supreme Court ruling in NFIB v. Sebelius (2012) regarding ACA Medicaid expansion?

States may choose whether to expand Medicaid without losing existing federal Medicaid funding (Correct answer)
States are required to expand Medicaid or lose all federal Medicaid funding
All states must expand Medicaid within 2 years
Medicaid expansion was ruled unconstitutional

Correct answer: States may choose whether to expand Medicaid without losing existing federal Medicaid funding

In NFIB v. Sebelius, the Supreme Court ruled that states could opt out of Medicaid expansion without losing their existing federal Medicaid funding, making expansion voluntary.

Question 11: Which ACA provision allowed states to extend Medicaid coverage to former foster youth up to age 26 regardless of income?

Section 1401 of the ACA
Section 2715 of the ACA
Section 1311 of the ACA
Section 2004 of the ACA (Correct answer)

Correct answer: Section 2004 of the ACA

ACA Section 2004 requires states to provide Medicaid coverage to former foster care youth up to age 26 regardless of income level.

Question 12: What is the minimum actuarial value for an employer-sponsored plan to meet the ACA's 'minimum value' standard?

70%
50%
80%
60% (Correct answer)

Correct answer: 60%

An employer plan must have an actuarial value of at least 60% to satisfy the minimum value requirement and protect employers from applicable ACA penalties.

Question 13: Who qualifies for Medicaid under the ACA expansion?

Only children and pregnant women
Only unemployed individuals
Only individuals over age 65
Low-income adults meeting federal poverty guidelines (Correct answer)

Correct answer: Low-income adults meeting federal poverty guidelines

Medicaid expansion under the ACA provides coverage to low-income individuals with income up to 138% of the federal poverty level.

Question 14: What is a Section 1115 waiver in the context of ACA Medicaid programs?

An automatic waiver granted to all states that expand Medicaid
A demonstration waiver allowing states to test innovative Medicaid delivery or financing approaches with federal approval (Correct answer)
A waiver allowing states to reduce benefits below ACA minimums permanently
A waiver exempting states from CHIP maintenance of effort requirements

Correct answer: A demonstration waiver allowing states to test innovative Medicaid delivery or financing approaches with federal approval

Section 1115 waivers allow states to test and evaluate new Medicaid approaches—including work requirements, alternative benefit designs, and delivery reforms—subject to federal budget neutrality and CMS approval.

Question 15: Which of the following is NOT one of the 10 Essential Health Benefits under the ACA?

Maternity and newborn care
Mental health and substance use disorder services
Emergency services
Adult dental care (Correct answer)

Correct answer: Adult dental care

Adult dental care is not one of the 10 EHBs; pediatric oral care is required, but comprehensive adult dental coverage is not mandated.

Question 16: Which of the following best describes 'cost-sharing reductions' (CSRs) under the ACA?

Tax deductions for health insurance premiums paid by self-employed individuals
Reductions in premium costs available to all marketplace enrollees
Subsidies that lower deductibles and copays for Silver plan enrollees with qualifying incomes (Correct answer)
Employer contributions toward employee health insurance premiums

Correct answer: Subsidies that lower deductibles and copays for Silver plan enrollees with qualifying incomes

CSRs reduce out-of-pocket costs such as deductibles, copays, and coinsurance for Silver plan enrollees with household incomes between 100% and 250% of the Federal Poverty Level.

Question 17: Under the ACA, what is the Modified Adjusted Gross Income (MAGI) methodology used for in Medicaid eligibility?

To assess asset tests for long-term care Medicaid eligibility
To standardize income counting rules across Medicaid, CHIP, and the Marketplace (Correct answer)
To determine if an individual qualifies for Medicare Part D low-income subsidies
To calculate the amount of premium tax credits for employer plans

Correct answer: To standardize income counting rules across Medicaid, CHIP, and the Marketplace

MAGI-based income rules were introduced by the ACA to create a uniform income-counting methodology across Medicaid, CHIP, and Marketplace subsidies, replacing varied state methodologies.

Question 18: Which provision of the ACA prohibits insurance companies from denying coverage based on pre-existing conditions?

Guaranteed Issue Provision (Correct answer)
Individual Mandate
Employer Mandate
Medicaid Expansion

Correct answer: Guaranteed Issue Provision

The ACA includes a provision that ensures individuals with pre-existing conditions cannot be denied health coverage.

Question 19: Which ACA section established the Basic Health Program (BHP), an optional coverage alternative for states serving low-income residents?

Section 1311
Section 1331 (Correct answer)
Section 2001
Section 1402

Correct answer: Section 1331

ACA Section 1331 established the Basic Health Program, which allows states to create a state-administered coverage program for residents earning between 133–200% FPL instead of enrolling them in Marketplace plans.

Question 20: Which IRS code section governs the employer shared responsibility (pay-or-play) provisions under the ACA?

IRC Section 6056
IRC Section 5000A
IRC Section 4980H (Correct answer)
IRC Section 36B

Correct answer: IRC Section 4980H

IRC Section 4980H contains the ACA's employer shared responsibility provisions, establishing the 'A' and 'B' penalty frameworks for ALEs.

Question 21: Which population benefits most from Medicaid expansion under the ACA?

Only self-employed individuals
Low-income adults under age 65 (Correct answer)
Only individuals over age 65
High-income earners

Correct answer: Low-income adults under age 65

Medicaid expansion under the ACA extends coverage to low-income adults who previously did not qualify for Medicaid.

Question 22: What is the actuarial value of a Gold plan under the ACA?

70%
60%
80% (Correct answer)
90%

Correct answer: 80%

Gold plans have an actuarial value of 80%, meaning the plan pays 80% of covered healthcare costs on average for a standard population.

Question 23: Under the ACA, what is the Children's Health Insurance Program (CHIP) primarily designed to cover?

Uninsured children in families with incomes too high for Medicaid but who cannot afford private coverage (Correct answer)
Foster children in state custody regardless of income
Children of federal employees not covered by employer plans
Children in families earning below 100% FPL who qualify for Medicaid

Correct answer: Uninsured children in families with incomes too high for Medicaid but who cannot afford private coverage

CHIP covers uninsured children in low-to-moderate income families that earn too much to qualify for Medicaid but cannot afford private insurance.

Question 24: What does 'actuarial value' represent in an ACA health plan?

The annual deductible a member must satisfy before coverage begins
The standard copay amount for primary care visits
The maximum premium an insurer can charge
The percentage of total covered healthcare costs the plan pays on average (Correct answer)

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

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

Question 25: A navigator is asked by their organization to track how many clients enroll in a specific insurer's plan. What ethical issue does this raise?

A HIPAA violation regardless of purpose
A conflict of interest if the tracking is used to incentivize navigator behavior toward that insurer (Correct answer)
An issue only if clients are informed about the tracking
No issue; data collection is a normal part of grant reporting

Correct answer: A conflict of interest if the tracking is used to incentivize navigator behavior toward that insurer

If plan-specific tracking creates pressure to steer clients toward particular insurers, it compromises the assister's obligation to provide impartial assistance.

Question 26: Which of the following is a permissible safe harbor an employer can use to demonstrate affordability of coverage under the ACA?

The W-2 wages safe harbor (Correct answer)
The employer's total revenue safe harbor
The state wage index safe harbor
The employer size safe harbor

Correct answer: The W-2 wages safe harbor

The W-2 wages safe harbor allows employers to determine affordability by ensuring the employee's contribution does not exceed the affordability percentage of W-2 box 1 wages.

Question 27: What is the primary advantage of a Bronze plan for a relatively healthy individual?

Lower out-of-pocket maximums
Lower deductibles than other metal tiers
Lower monthly premiums (Correct answer)
Access to a wider provider network

Correct answer: Lower monthly premiums

Bronze plans offer the lowest monthly premiums of all metal tiers, making them cost-effective for individuals who rarely use healthcare services.

Question 28: Which tool or methodology is most appropriate for analyzing policies & regulations outcomes?

Maintaining strict formality that inhibits collaboration
Adjusting boundaries based on individual situations without guidelines
Prioritizing relationships over professional standards
Maintaining professional boundaries while building collaborative relationships (Correct answer)

Correct answer: Maintaining professional boundaries while building collaborative relationships

Maintaining professional boundaries while building collaborative relationships is the correct approach because effective policies & regulations in the affordable care act certified field requires adherence to professional standards, evidence-based practices, and systematic methodology. This approach ensures consistent, high-quality outcomes while maintaining professional accountability.

Question 29: A Health Savings Account (HSA) can be used in conjunction with which type of ACA health plan?

Any HMO plan
Any Bronze plan
An HSA-qualified High-Deductible Health Plan (HDHP) (Correct answer)
A Platinum plan

Correct answer: An HSA-qualified High-Deductible Health Plan (HDHP)

HSAs are only available to individuals enrolled in IRS-qualified HDHPs that meet the minimum deductible and maximum out-of-pocket thresholds set by the IRS.

Question 30: How is eligibility for ACA tax credits determined?

For individuals with pre-existing conditions only
Based on income and family size (Correct answer)
Only for people over 65
Based only on employment status

Correct answer: Based on income and family size

Eligibility for ACA tax credits is based on household income and family size relative to the federal poverty level.

Affordable Care Act (ACA) Marketplace Certification (FFM)

The CMS Federally Facilitated Marketplace (FFM) certification validates that health insurance agents and brokers have the knowledge to assist consumers with ACA Marketplace enrollment, eligibility, plan selection, and compliance. Passing requires 70% or higher on each of four module-based exams.

Questions

35 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds