CACs Marketplace Plan Options 3 — Questions and Answers
Question 1: A client is eligible for both a premium tax credit and Cost-Sharing Reductions. To receive BOTH benefits, which plan must they select?
- Any Marketplace plan
- A Bronze plan only
- A Silver plan (Correct answer)
- A Platinum plan
Correct answer: A Silver plan
While premium tax credits can be applied to any metal tier, CSRs are only available when the enrollee selects a Silver plan.
Question 2: Which of the following is NOT a standard metal tier offered in the Health Insurance Marketplace?
- Bronze
- Silver
- Diamond (Correct answer)
- Gold
Correct answer: Diamond
The standard Marketplace metal tiers are Bronze, Silver, Gold, and Platinum; Diamond is not an ACA plan category.
Question 3: A Silver plan with Cost-Sharing Reductions for a consumer at 150% FPL will have an actuarial value closest to which percentage?
- 70%
- 73%
- 87%
- 94% (Correct answer)
Correct answer: 94%
At 100–150% FPL, CSR-enhanced Silver plans can reach an actuarial value of approximately 94%, providing very rich coverage.
Question 4: Which cost-sharing feature do Catastrophic plans require enrollees to meet before coverage kicks in for most services?
- A low copay for every visit
- A very high deductible equal to the annual out-of-pocket maximum (Correct answer)
- A fixed monthly coinsurance rate
- No cost-sharing at all
Correct answer: A very high deductible equal to the annual out-of-pocket maximum
Catastrophic plans have a very high deductible that equals the annual out-of-pocket limit, meaning enrollees pay nearly all costs until the maximum is reached.
Question 5: What must ALL Marketplace plans cover regardless of metal tier?
- Dental and vision benefits
- The 10 Essential Health Benefits (EHBs) (Correct answer)
- Long-term care services
- Elective cosmetic procedures
Correct answer: The 10 Essential Health Benefits (EHBs)
All Marketplace qualified health plans must cover the 10 Essential Health Benefits as required by the ACA.
Question 6: A client says their employer offered coverage but they find it unaffordable. Under ACA rules, when is employer-sponsored coverage considered 'unaffordable'?
- When the employee's share of self-only premium exceeds 9.02% of household income (2024 threshold) (Correct answer)
- When the total family premium exceeds $500/month
- When the deductible is over $3,000
- When the plan does not cover dental
Correct answer: When the employee's share of self-only premium exceeds 9.02% of household income (2024 threshold)
Employer coverage is deemed unaffordable if the employee's share of the self-only premium exceeds the IRS affordability threshold (approximately 9% of household income, adjusted annually).
Question 7: Which statement correctly describes how premium tax credits interact with metal tiers?
- Credits can only be applied to Silver plans
- Credits can be applied to Bronze, Silver, Gold, or Platinum plans (Correct answer)
- Credits can be applied to any plan including Catastrophic
- Credits automatically select the cheapest Bronze plan
Correct answer: Credits can be applied to Bronze, Silver, Gold, or Platinum plans
Premium tax credits can be applied to any of the four standard metal tier plans (Bronze through Platinum), though not to Catastrophic plans.
CACs Marketplace Plan Options 3
A client is eligible for both a premium tax credit and Cost-Sharing Reductions.
To receive BOTH benefits, which plan must they select?