CACs - Certified Application Counselor Marketplace Plan Options Questions and Answers 1

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

Bronze plans are designed to have the lowest monthly premiums but the highest out-of-pocket costs, such as deductibles and copayments, when care is needed. This structure is suitable for healthy individuals who primarily want coverage for major accidents or illnesses.

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

Cost-Sharing Reductions (CSRs), often called 'extra savings,' are only available to eligible individuals who enroll in a Silver plan. These savings lower out-of-pocket costs like deductibles and copays for consumers with household incomes between 100% and 250% of the FPL.

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

The Affordable Care Act (ACA) requires that all individual and small group plans, including those on the Marketplace, cover 10 Essential Health Benefits. These include categories like maternity care, prescription drugs, and mental health services. Cosmetic surgery that is not medically necessary is not an essential health benefit.

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

Losing other health coverage, such as from a job, is a Qualifying Life Event (QLE) that allows an individual to enroll in a new health plan outside of the regular Open Enrollment Period. This window of opportunity is called a Special Enrollment Period (SEP).

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

Catastrophic plans are generally only available to individuals under the age of 30 or those who qualify for a hardship or affordability exemption. Since the individual is 35 and does not have an exemption, they are not eligible for this type of plan.

(CACs) Certified Application Counselor Practice Test

(CACs) Certified Application Counselor Practice Test

CACs - Certified Application Counselor Marketplace Plan Options Questions and Answers 1