Marketplace Plan Options Flashcards
7 cards from real CACS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Marketplace Plan Options flashcards as text
Which metal tier plan typically has the lowest monthly premium but the highest out-of-pocket costs when care is needed?
Answer: Bronze
Bronze plans have the lowest premiums but require enrollees to pay more out-of-pocket when they use healthcare services.
A client wants a plan where their insurer pays about 80% of covered costs on average. Which metal tier should they choose?
Answer: Gold
Gold plans are designed so the insurance company pays roughly 80% of covered healthcare costs on average.
What is the actuarial value of a Platinum plan?
Answer: 90%
Platinum plans have an actuarial value of 90%, meaning the insurer covers about 90% of covered medical costs on average.
Which plan type is ONLY available to people under age 30 or those who qualify for a hardship or affordability exemption?
Answer: Catastrophic
Catastrophic plans are restricted to individuals under 30 or those who qualify for specific exemptions.
Cost-Sharing Reductions (CSRs) are ONLY available to eligible enrollees who select which metal tier?
Answer: Silver
CSRs are exclusively applied to Silver plans, reducing deductibles, copays, and out-of-pocket maximums for eligible low-income enrollees.
A 28-year-old healthy individual with no subsidies wants the absolute lowest premium possible on the Marketplace. Which plan type should a CAC present first?
Answer: Catastrophic
Catastrophic plans offer the lowest premiums and are available to individuals under 30, making them ideal for young, healthy people without subsidies.
Which statement about Marketplace plan networks is correct?
Answer: Plans can use HMO, PPO, EPO, or POS network types regardless of metal tier
Marketplace plans across all metal tiers can be structured as HMO, PPO, EPO, or POS plans, and the network type is independent of the metal tier.