ACA Essential Health Benefits & Plan Types 1 — Questions and Answers
Question 1: Which of the following is one of the 10 Essential Health Benefits mandated by the ACA?
- Dental care for adults
- Pediatric services, including oral and vision care (Correct answer)
- Long-term nursing home care
- Cosmetic surgery
Correct answer: Pediatric services, including oral and vision care
Pediatric services including oral and vision care is one of the 10 mandated EHBs; adult dental, long-term care, and cosmetic surgery are not included.
Question 2: What is the actuarial value of a Gold plan under the ACA?
- 60%
- 70%
- 80% (Correct answer)
- 90%
Correct answer: 80%
Gold plans have an actuarial value of 80%, meaning the plan pays 80% of covered healthcare costs on average for a standard population.
Question 3: Which metal tier has the HIGHEST actuarial value under the ACA?
- Bronze
- Silver
- Gold
- Platinum (Correct answer)
Correct answer: Platinum
Platinum plans have the highest actuarial value of 90%, meaning insurers cover 90% of covered healthcare costs for a standard population.
Question 4: What is the actuarial value of a Silver plan in the ACA marketplace?
- 60%
- 70% (Correct answer)
- 80%
- 90%
Correct answer: 70%
Silver plans have an actuarial value of 70%, covering 70% of expected covered healthcare costs on average.
Question 5: Which of the following is NOT one of the 10 Essential Health Benefits under the ACA?
- Maternity and newborn care
- Emergency services
- Adult dental care (Correct answer)
- Mental health and substance use disorder services
Correct answer: Adult dental care
Adult dental care is not one of the 10 EHBs; pediatric oral care is required, but comprehensive adult dental coverage is not mandated.
Question 6: Which plan type is the basis for calculating Premium Tax Credits in the ACA marketplace?
- Bronze plan
- Silver plan (Correct answer)
- Gold plan
- Platinum plan
Correct answer: Silver plan
Premium Tax Credits are calculated based on the cost of the second-lowest-cost Silver plan (SLCSP) available in the applicant's geographic area.
Question 7: What is the actuarial value of a Bronze plan in the ACA marketplace?
- 50%
- 60% (Correct answer)
- 70%
- 80%
Correct answer: 60%
Bronze plans have an actuarial value of 60%, providing the lowest coverage level but typically the lowest monthly premiums.
ACA Essential Health Benefits & Plan Types 1
Which of the following is one of the 10 Essential Health Benefits mandated by the ACA?