CEC ACA & Marketplace Fundamentals 4

Question 1

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

Accepted Answer

$9,450

Answer

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.

Question 2

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

Accepted Answer

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

Answer

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.

Question 3

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

Accepted Answer

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

Answer

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

Question 4

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

Accepted Answer

California

Answer

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

Question 5

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

Accepted Answer

70%

Answer

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

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC ACA & Marketplace Fundamentals 4