CACs Healthcare Programs & Coverage Options 2

Question 1

Which metal tier plan on the Marketplace typically has the lowest monthly premium but highest out-of-pocket costs when care is received?

Accepted Answer

Bronze

Answer

Bronze plans have the lowest premiums but highest out-of-pocket costs, covering roughly 60% of average costs.

Question 2

A family's income is 210% of the Federal Poverty Level. Which cost-sharing reduction (CSR) tier applies if they enroll in a Silver plan?

Accepted Answer

73% actuarial value tier

Answer

Incomes between 200–250% FPL qualify for the 73% AV CSR tier on Silver plans.

Question 3

CHIP (Children's Health Insurance Program) primarily covers which population?

Accepted Answer

Uninsured children in families who earn too much for Medicaid but too little to afford private coverage

Answer

CHIP targets uninsured children in families whose income exceeds Medicaid limits but who cannot afford private insurance.

Question 4

What is the income threshold (as a percentage of FPL) below which adults in Medicaid expansion states generally qualify for Medicaid under the ACA?

Accepted Answer

133% (effectively 138% with the 5% income disregard)

Answer

ACA expansion covers adults up to 133% FPL, and with the mandatory 5% income disregard, the effective limit is 138% FPL.

Question 5

Which Marketplace plan network type generally requires members to choose a primary care physician and get referrals to see specialists?

Accepted Answer

HMO

Answer

HMO (Health Maintenance Organization) plans require a PCP selection and referrals for specialist visits.

(CACs) Certified Application Counselor Practice Test