CACs Health Coverage Programs 2 — Questions and Answers
Question 1: Which federal program provides health coverage to people with end-stage renal disease (ESRD) regardless of age?
- Medicaid
- CHIP
- Medicare (Correct answer)
- COBRA
Correct answer: Medicare
Medicare covers individuals with ESRD regardless of age because it is a specific eligibility pathway under Medicare Part A and Part B.
Question 2: Under the ACA, which metal tier plan covers approximately 90% of average healthcare costs?
- Bronze
- Silver
- Gold
- Platinum (Correct answer)
Correct answer: Platinum
Platinum plans have the highest actuarial value at approximately 90%, meaning the plan covers about 90% of average covered costs.
Question 3: A family's Modified Adjusted Gross Income (MAGI) is used to determine eligibility for which programs?
- Medicare and TRICARE
- Marketplace plans and Medicaid (Correct answer)
- COBRA and Medicare
- CHIP and TRICARE
Correct answer: Marketplace plans and Medicaid
MAGI-based income rules apply to Marketplace coverage, premium tax credits, cost-sharing reductions, Medicaid, and CHIP eligibility determinations.
Question 4: What is the purpose of a Special Enrollment Period (SEP)?
- To allow enrollment only during the Open Enrollment Period
- To penalize late enrollees
- To permit enrollment outside the standard Open Enrollment Period due to a qualifying life event (Correct answer)
- To extend premium tax credits beyond the standard period
Correct answer: To permit enrollment outside the standard Open Enrollment Period due to a qualifying life event
SEPs allow consumers who experience qualifying life events — such as losing coverage, marriage, or moving — to enroll in a health plan outside Open Enrollment.
Question 5: Which program offers coverage to children in families that earn too much for Medicaid but cannot afford private insurance?
- Medicare
- CHIP (Correct answer)
- TRICARE
- Marketplace Platinum plan
Correct answer: CHIP
CHIP (Children's Health Insurance Program) fills the coverage gap for children in families whose income exceeds Medicaid limits but is still low enough to qualify for subsidized coverage.
Question 6: What is an actuarial value (AV) in the context of Marketplace metal tiers?
- The monthly premium amount a consumer pays
- The percentage of total average costs a plan covers for a standard population (Correct answer)
- The maximum out-of-pocket limit for a plan year
- The deductible amount before the plan pays
Correct answer: The percentage of total average costs a plan covers for a standard population
Actuarial value represents the average percentage of covered medical costs the plan pays for a standard population, determining the metal tier classification.
Question 7: Which of the following is NOT a qualifying life event that triggers a Special Enrollment Period?
- Getting married
- Having a baby
- Voluntarily dropping existing coverage (Correct answer)
- Moving to a new coverage area
Correct answer: Voluntarily dropping existing coverage
Voluntarily dropping coverage is not a qualifying life event; SEPs are triggered by involuntary loss of coverage or significant life changes, not personal choice to disenroll.
CACs Health Coverage Programs 2
Which federal program provides health coverage to people with end-stage renal disease (ESRD) regardless of age?