CACs Affordable Care Act Basics 3 — Questions and Answers
Question 1: Under the ACA, which metal tier plan has the HIGHEST actuarial value?
- Bronze
- Silver
- Gold
- Platinum (Correct answer)
Correct answer: Platinum
Platinum plans have the highest actuarial value at approximately 90%, meaning the plan pays about 90% of covered medical costs on average.
Question 2: Cost-Sharing Reductions (CSRs) under the ACA are ONLY available with which metal tier plan?
- Bronze
- Silver (Correct answer)
- Gold
- Any metal tier
Correct answer: Silver
CSRs are only applied to Silver plans; eligible individuals must enroll in a Silver plan to receive reduced deductibles, copays, and out-of-pocket maximums.
Question 3: A family of four with an income of 200% FPL applies for coverage. Which program should they FIRST be screened for?
- Only Marketplace plans with APTC
- Medicaid and CHIP before Marketplace plans (Correct answer)
- Medicare
- Short-term health plans
Correct answer: Medicaid and CHIP before Marketplace plans
CACs must screen all applicants for Medicaid and CHIP eligibility first, as these programs may provide more comprehensive and cost-effective coverage.
Question 4: What is the primary purpose of the Summary of Benefits and Coverage (SBC) document?
- To list all network providers
- To provide a standardized comparison of plan costs and coverage (Correct answer)
- To detail the plan's prescription drug formulary
- To explain prior authorization requirements
Correct answer: To provide a standardized comparison of plan costs and coverage
The SBC is a standardized, easy-to-understand summary that allows consumers to compare plans based on key costs and coverage details.
Question 5: Which ACA provision allows young adults to remain on a parent's health insurance plan?
- The dependent care provision up to age 19
- Young adult coverage up to age 26 (Correct answer)
- Student health plan extension to age 23
- Dependent coverage until marriage or employment
Correct answer: Young adult coverage up to age 26
The ACA requires plans that cover dependents to offer coverage to adult children up to age 26, regardless of student, marital, or financial dependency status.
Question 6: What is 'guaranteed issue' under the ACA?
- The guarantee that premiums will not increase
- The requirement that insurers must accept all applicants regardless of health status (Correct answer)
- A guarantee of government subsidies for all applicants
- The assurance that all claims will be paid
Correct answer: The requirement that insurers must accept all applicants regardless of health status
Guaranteed issue means health insurers must offer and sell coverage to any applicant who applies during open or special enrollment, regardless of pre-existing conditions.
Question 7: Under the ACA, what is the standard Open Enrollment Period (OEP) for the individual Marketplace?
- January 1 – March 31
- October 15 – December 7
- November 1 – January 15 (Correct answer)
- September 1 – October 31
Correct answer: November 1 – January 15
The standard ACA Open Enrollment Period runs November 1 through January 15 for most states, with coverage starting January 1 or February 1 depending on enrollment date.
CACs Affordable Care Act Basics 3
Under the ACA, which metal tier plan has the HIGHEST actuarial value?