CES Premium and Cost-Sharing 2

Question 1

Cost-sharing reductions (CSR) improve coverage for eligible individuals by:

Accepted Answer

Lowering deductibles, copayments, and out-of-pocket maximums within a Silver plan

Answer

Reducing monthly premiums to zero

Answer

Eliminating the need for prior authorizations

Answer

Providing free dental and vision coverage

Question 2

At 150% FPL, a CSR-eligible enrollee in a Silver plan would have an actuarial value of approximately:

Accepted Answer

94%

Answer

70%

Answer

73%

Answer

87%

Question 3

What is the minimum value standard for employer-sponsored health insurance under the ACA?

Accepted Answer

60% actuarial value

Answer

50% actuarial value

Answer

70% actuarial value

Answer

80% actuarial value

Question 4

For employer-sponsored coverage to be considered 'affordable' under the ACA in 2025, the employee's share of self-only premium must not exceed what percentage of household income?

Accepted Answer

9.12%

Answer

8.39%

Answer

9.83%

Answer

10.50%

Question 5

A member has a $2,000 deductible and 20% coinsurance with a $6,000 out-of-pocket maximum. After paying the deductible, they incur $20,000 in additional covered charges. What is their total out-of-pocket cost?

Accepted Answer

$6,000 (capped at OOP max)

Answer

$2,000 + $4,000 = $6,000

Answer

$2,000 + $20,000 = $22,000

Answer

$4,000 (20% of $20,000)

Question 6

Under the ACA, cost-sharing for recommended preventive services must be waived for which plan types?

Accepted Answer

Non-grandfathered individual and employer group plans

Answer

All health plans including grandfathered plans

Answer

Only Marketplace plans

Answer

Only fully insured plans, not self-funded plans