CACs Healthcare Programs & Coverage Options 3 — Questions and Answers
Question 1: Under the ACA, which of the following is NOT classified as an Essential Health Benefit (EHB) that Marketplace plans must cover?
- Emergency services
- Pediatric dental and vision
- Adult dental care (Correct answer)
- Mental health and substance use disorder services
Correct answer: Adult dental care
Adult dental care is not an Essential Health Benefit; EHBs include pediatric dental/vision but not routine adult dental coverage.
Question 2: A 28-year-old healthy individual with no chronic conditions wants the lowest possible premium. Which plan type might a CAC explain is available only to people under 30?
- Silver plan
- Bronze plan
- Catastrophic plan (Correct answer)
- Platinum plan
Correct answer: Catastrophic plan
Catastrophic plans are available to people under 30 (and some with hardship exemptions) and feature very low premiums but high deductibles.
Question 3: The Basic Health Program (BHP) is an optional ACA program that allows states to offer coverage to individuals with incomes between what FPL range who would otherwise be eligible for Marketplace subsidies?
- 100–133% FPL
- 133–200% FPL (Correct answer)
- 200–250% FPL
- 250–400% FPL
Correct answer: 133–200% FPL
The BHP serves individuals at 133–200% FPL (above Medicaid threshold) with more stable, lower-cost coverage than Marketplace plans.
Question 4: Which of the following statements about Advance Premium Tax Credits (APTC) is correct?
- APTC can only be applied to Gold or Platinum plans
- APTC is paid directly to the insurer to lower monthly premiums (Correct answer)
- APTC is only available in non-Medicaid expansion states
- APTC cannot be reconciled when filing federal taxes
Correct answer: APTC is paid directly to the insurer to lower monthly premiums
APTC is sent directly to the insurance company, reducing the consumer's monthly premium payment.
Question 5: COBRA continuation coverage allows workers who lose job-based coverage to continue their employer plan for up to how long?
- 6 months
- 12 months
- 18 months (Correct answer)
- 36 months
Correct answer: 18 months
COBRA generally allows continuation of group health coverage for up to 18 months after qualifying events like job loss.
Question 6: A pregnant woman applying for coverage should be informed that pregnancy alone qualifies her for what type of Special Enrollment Period trigger?
- Loss of minimum essential coverage
- Birth, adoption, or placement for foster care (Correct answer)
- Gaining a dependent or marriage
- Exceptional circumstances SEP
Correct answer: Birth, adoption, or placement for foster care
A baby's birth (anticipated or actual) qualifies as a life event triggering a Special Enrollment Period under the birth/adoption/foster care category.
Question 7: Which of the following describes 'minimum essential coverage' (MEC)?
- Coverage that meets only the Bronze plan actuarial value standard
- Any qualifying health coverage that satisfies ACA requirements, including Medicaid and employer-sponsored plans (Correct answer)
- Only Marketplace Qualified Health Plans
- Coverage providing all 10 Essential Health Benefits
Correct answer: Any qualifying health coverage that satisfies ACA requirements, including Medicaid and employer-sponsored plans
MEC is a broad category of qualifying coverage including Medicaid, Medicare, employer plans, and Marketplace QHPs.
CACs Healthcare Programs & Coverage Options 3
Under the ACA, which of the following is NOT classified as an Essential Health Benefit (EHB) that Marketplace plans must cover?