CACs - Certified Application Counselor Marketplace Plan Options Questions and Answers

Question 1

A 28-year-old single individual is in good health and wants a Marketplace plan with the lowest possible monthly premium.
They understand that this means they will have a high deductible and will pay more for care when they need it.
Which 'metal level' plan would be the most appropriate recommendation?

Accepted Answer

Bronze

Answer

Gold

Answer

Silver

Answer

Platinum

Question 2

An applicant with a household income at 180% of the Federal Poverty Level (FPL) wants to receive financial assistance to lower their deductibles, copayments, and coinsurance. To receive these specific 'extra savings,' which type of Marketplace plan MUST they enroll in?

Accepted Answer

A Silver plan

Answer

Any plan offered on the Marketplace

Answer

A Gold or Platinum plan

Answer

A Bronze plan

Question 3

Which of the following is NOT considered one of the 10 Essential Health Benefits that all Marketplace plans are required to cover?

Accepted Answer

Cosmetic surgery

Answer

Maternity and newborn care

Answer

Prescription drugs

Answer

Mental health and substance use disorder services

Question 4

A consumer loses their job-based health coverage on June 15th. They want to enroll in a Marketplace plan. This situation is known as a Qualifying Life Event (QLE), which triggers what opportunity for the consumer?

Accepted Answer

A Special Enrollment Period (SEP)

Answer

A discount on their first month's premium

Answer

An automatic enrollment into a Gold plan

Answer

An exemption from all out-of-pocket costs

Question 5

A 35-year-old individual wants to purchase a Catastrophic health plan because of its very low premium. They do not qualify for a hardship or affordability exemption. As a Certified Application Counselor, what should you advise them?

Accepted Answer

They are not eligible for a Catastrophic plan due to their age.

Answer

They can enroll in a Catastrophic plan without any restrictions.

Answer

They can only enroll if they also sign up for a dental plan.

Answer

They must first enroll in a Bronze plan for one year.

Question 6

A family is comparing a Health Maintenance Organization (HMO) plan and a Preferred Provider Organization (PPO) plan on the Marketplace. What is a key difference a CAC should explain to them?

Accepted Answer

HMOs only cover services from in-network providers (except in emergencies), while PPOs offer some coverage for out-of-network care.

Answer

HMO plans have higher premiums than PPO plans.

Answer

PPO plans generally require referrals to see specialists, while HMOs do not.

Answer

Only PPO plans cover the 10 Essential Health Benefits.