CEC Health Coverage Options & Program Eligibility 5

Question 1

Which of the following coverage scenarios triggers a 'minimum essential coverage' standard under the ACA?

Accepted Answer

Marketplace Qualified Health Plans

Answer

Marketplace Qualified Health Plans meet the ACA's minimum essential coverage (MEC) standard; short-term plans and discount cards generally do not.

Question 2

An applicant is a U.S. citizen living abroad permanently. Are they eligible for Marketplace coverage?

Accepted Answer

No, they must reside in the United States to enroll

Answer

Marketplace eligibility requires residing in the United States; U.S. citizens living abroad are not eligible to enroll in Marketplace plans.

Question 3

What is the primary difference between an HMO and an EPO health plan?

Accepted Answer

HMOs require referrals for specialists; EPOs generally do not but restrict to network

Answer

HMOs typically require PCP referrals for specialist visits, while EPOs allow direct specialist access but still restrict coverage to in-network providers.

Question 4

A person is incarcerated awaiting trial (pre-trial detention). Are they eligible for Marketplace coverage?

Accepted Answer

Yes, people in pre-trial detention may be eligible

Answer

The ACA excludes individuals 'incarcerated' after conviction from Marketplace plans, but individuals in pre-trial detention are generally considered eligible.

Question 5

Which term describes the amount a consumer must pay out-of-pocket before their insurance begins to cover most services?

Accepted Answer

Deductible

Answer

The deductible is the amount a consumer pays before the insurer begins sharing costs; once met, cost-sharing (copays/coinsurance) applies for most services.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Health Coverage Options & Program Eligibility 5