CACs Marketplace Plan Options 2 — Questions and Answers
Question 1: Which metal tier plan typically has the lowest monthly premium but the highest out-of-pocket costs when care is needed?
- Bronze (Correct answer)
- Silver
- Gold
- Platinum
Correct answer: Bronze
Bronze plans have the lowest premiums but require enrollees to pay more out-of-pocket when they use healthcare services.
Question 2: A client wants a plan where their insurer pays about 80% of covered costs on average. Which metal tier should they choose?
- Bronze
- Silver
- Gold (Correct answer)
- Catastrophic
Correct answer: Gold
Gold plans are designed so the insurance company pays roughly 80% of covered healthcare costs on average.
Question 3: What is the actuarial value of a Platinum plan?
- 70%
- 80%
- 90% (Correct answer)
- 100%
Correct answer: 90%
Platinum plans have an actuarial value of 90%, meaning the insurer covers about 90% of covered medical costs on average.
Question 4: Which plan type is ONLY available to people under age 30 or those who qualify for a hardship or affordability exemption?
- Bronze
- Silver
- Gold
- Catastrophic (Correct answer)
Correct answer: Catastrophic
Catastrophic plans are restricted to individuals under 30 or those who qualify for specific exemptions.
Question 5: Cost-Sharing Reductions (CSRs) are ONLY available to eligible enrollees who select which metal tier?
- Bronze
- Silver (Correct answer)
- Gold
- Platinum
Correct answer: Silver
CSRs are exclusively applied to Silver plans, reducing deductibles, copays, and out-of-pocket maximums for eligible low-income enrollees.
Question 6: A 28-year-old healthy individual with no subsidies wants the absolute lowest premium possible on the Marketplace. Which plan type should a CAC present first?
- Bronze
- Silver
- Gold
- Catastrophic (Correct answer)
Correct answer: Catastrophic
Catastrophic plans offer the lowest premiums and are available to individuals under 30, making them ideal for young, healthy people without subsidies.
Question 7: Which statement about Marketplace plan networks is correct?
- All plans in the same metal tier share the same provider network
- Plans can use HMO, PPO, EPO, or POS network types regardless of metal tier (Correct answer)
- Only Gold and Platinum plans can offer PPO networks
- Catastrophic plans must use EPO networks by law
Correct answer: Plans can use HMO, PPO, EPO, or POS network types regardless of metal tier
Marketplace plans across all metal tiers can be structured as HMO, PPO, EPO, or POS plans, and the network type is independent of the metal tier.
CACs Marketplace Plan Options 2
Which metal tier plan typically has the lowest monthly premium but the highest out-of-pocket costs when care is needed?