AHIP MCQ 5 — Questions and Answers
Question 1: Under the ACA's essential health benefits (EHBs), which of the following is NOT required to be covered by individual and small group health plans?
- Mental health and substance use disorder services
- Pediatric services including oral and vision care
- Long-term custodial nursing home care (Correct answer)
- Maternity and newborn care
Correct answer: Long-term custodial nursing home care
Long-term custodial care is not an essential health benefit under the ACA; the ten EHBs focus on acute and preventive health services.
Question 2: What does the term 'creditable coverage' mean in the context of Medicare Part D?
- Coverage that costs less than the national benchmark Part D premium
- Drug coverage that is at least as good as the standard Medicare Part D benefit (Correct answer)
- Coverage provided by a credentialed pharmacy benefit manager
- Any coverage that qualifies an individual for the Extra Help subsidy
Correct answer: Drug coverage that is at least as good as the standard Medicare Part D benefit
Creditable coverage for Part D is drug coverage expected to pay, on average, at least as much as the standard Medicare Part D benefit.
Question 3: A COBRA qualifying event occurs when an employee is terminated for gross misconduct. Which of the following is correct?
- COBRA continuation coverage is available but at full premium plus 102%
- COBRA coverage is not available because gross misconduct disqualifies the employee (Correct answer)
- COBRA applies but the employer must subsidize the premium
- COBRA applies for 18 months at reduced premium
Correct answer: COBRA coverage is not available because gross misconduct disqualifies the employee
Termination for gross misconduct specifically disqualifies an individual from COBRA continuation coverage under federal law.
Question 4: Which Medicare Supplement plan is the ONLY standardized plan that covers the Medicare Part B deductible for people who became eligible for Medicare on or after January 1, 2020?
- Plan F
- Plan G (Correct answer)
- Plan C
- Plan N
Correct answer: Plan G
For new Medicare eligibles on or after January 1, 2020, Plan G is the most comprehensive available since Plans C and F were discontinued for new enrollees.
Question 5: Under the Mental Health Parity and Addiction Equity Act (MHPAEA), how must plans treat mental health and substance use disorder benefits compared to medical/surgical benefits?
- Mental health benefits may have higher cost-sharing as long as they are covered
- Plans must cover mental health but may impose stricter visit limits
- Financial requirements and treatment limitations must be no more restrictive than those for medical/surgical benefits (Correct answer)
- Plans must provide unlimited mental health visits at no cost-sharing
Correct answer: Financial requirements and treatment limitations must be no more restrictive than those for medical/surgical benefits
MHPAEA requires that financial requirements (like copays) and treatment limitations for mental health and SUD benefits be no more restrictive than the predominant limits applied to medical/surgical benefits.
Question 6: Which of the following describes a key feature of a Medicare Medical Savings Account (MSA) plan?
- The plan deposits money into an HSA that members can use for medical expenses
- The government deposits money into a bank account that can be used for Medicare-covered expenses (Correct answer)
- Members contribute pre-tax dollars monthly to a savings account paired with low deductibles
- MSA plans include Part D drug coverage automatically
Correct answer: The government deposits money into a bank account that can be used for Medicare-covered expenses
Medicare MSA plans combine a high-deductible MA plan with a savings account funded by CMS deposits to help pay for medical expenses.
Question 7: When an insurance agent is found to have 'churning' a Medicare beneficiary's plan enrollment, which regulatory body has primary oversight authority?
- The state department of insurance only
- The Centers for Medicare & Medicaid Services (CMS) and potentially the state insurance department (Correct answer)
- The Social Security Administration
- The Department of Labor
Correct answer: The Centers for Medicare & Medicaid Services (CMS) and potentially the state insurance department
CMS has federal oversight of Medicare Advantage marketing conduct, while state insurance departments also regulate agent licensure and conduct within their jurisdiction.
AHIP MCQ 5
Under the ACA's essential health benefits (EHBs), which of the following is NOT required to be covered by individual and small group health plans?