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ACA & Marketplace Fundamentals Flashcards

7 cards from real CEC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 ACA & Marketplace Fundamentals flashcards as text

  1. Under the ACA, what is the maximum annual out-of-pocket limit for a self-only Marketplace plan in 2024?

    Answer: $9,450

    For 2024, the ACA out-of-pocket maximum for self-only coverage is $9,450, limiting total cost-sharing exposure for in-network essential health benefits.

  2. What are the 10 Essential Health Benefits (EHBs) required to be covered in all Marketplace plans?

    Answer: Includes ambulatory services, emergency care, mental health, prescription drugs, and 6 others

    The 10 EHBs include ambulatory services, emergency care, hospitalization, maternity, mental health/substance use, prescription drugs, rehabilitative services, lab services, preventive care, and pediatric services.

  3. A Navigator is different from a licensed insurance agent/broker in that Navigators:

    Answer: Provide unbiased education and assistance but cannot recommend specific plans or receive compensation tied to enrollment

    Navigators provide free, unbiased enrollment assistance and education but are prohibited from recommending specific plans or accepting compensation from insurers.

  4. Which state runs its own fully state-based Marketplace (SBM) and does NOT use HealthCare.gov for enrollment?

    Answer: California

    California operates Covered California, a fully state-based Marketplace with its own enrollment platform separate from HealthCare.gov.

  5. What is the minimum actuarial value for a Silver plan under ACA metal tier standards?

    Answer: 70%

    Silver plans must have an actuarial value of approximately 70%, meaning the plan pays 70% of average costs for a standard population.

  6. An enrollee who is offered affordable employer coverage but wants to enroll in a Marketplace plan instead will generally:

    Answer: Not be eligible for APTC if the employer plan meets ACA affordability and minimum value standards

    If an employer plan is affordable and meets minimum value standards, the employee is not eligible for Marketplace premium tax credits (APTC).

  7. Which form does an insurer use to report Marketplace coverage to the IRS and send to enrollees for tax filing purposes?

    Answer: Form 1095-A

    Form 1095-A (Health Insurance Marketplace Statement) is issued by the Marketplace to enrollees and is required to complete Form 8962 for APTC reconciliation.