CEC ACA & Marketplace Fundamentals 2 — Questions and Answers
Question 1: Which federal agency oversees the Health Insurance Marketplace established under the ACA?
- Centers for Medicare & Medicaid Services (CMS) (Correct answer)
- Department of Labor
- Social Security Administration
- Office of Personnel Management
Correct answer: Centers for Medicare & Medicaid Services (CMS)
CMS is the federal agency responsible for administering and overseeing the ACA's Health Insurance Marketplace.
Question 2: What is the maximum income level (as a percentage of the Federal Poverty Level) at which individuals can qualify for premium tax credits on the Marketplace?
- 200% FPL
- 300% FPL
- 400% FPL
- No upper income limit (through 2025 under enhanced subsidies) (Correct answer)
Correct answer: No upper income limit (through 2025 under enhanced subsidies)
The American Rescue Plan Act temporarily eliminated the 400% FPL cap on premium tax credits, and this was extended through 2025 by the Inflation Reduction Act.
Question 3: A consumer who loses job-based coverage on June 15 has how many days to enroll in a Marketplace plan using a Special Enrollment Period?
- 30 days
- 60 days (Correct answer)
- 90 days
- 120 days
Correct answer: 60 days
Loss of minimum essential coverage triggers a 60-day Special Enrollment Period during which the consumer can enroll in a Marketplace plan.
Question 4: Which metal tier plan typically has the lowest monthly premium but highest out-of-pocket costs when care is used?
- Platinum
- Gold
- Silver
- Bronze (Correct answer)
Correct answer: Bronze
Bronze plans have the lowest premiums but highest cost-sharing (deductibles, copays, coinsurance), covering about 60% of average medical costs.
Question 5: Cost-sharing reductions (CSRs) are available exclusively with which Marketplace metal tier?
- Bronze
- Silver (Correct answer)
- Gold
- Platinum
Correct answer: Silver
CSRs are only available when a consumer enrolls in a Silver plan, automatically reducing deductibles, copays, and out-of-pocket maximums.
Question 6: What document serves as the primary legal authority establishing the Health Insurance Marketplace?
- ERISA
- HIPAA
- Patient Protection and Affordable Care Act (ACA) (Correct answer)
- COBRA
Correct answer: Patient Protection and Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act, signed in 2010, established the Health Insurance Marketplace as a key component of health reform.
Question 7: Which of the following is NOT a type of health plan available through the ACA Marketplace?
- HMO
- PPO
- EPO
- Indemnity Plan (Correct answer)
Correct answer: Indemnity Plan
Traditional indemnity (fee-for-service) plans are generally not offered through the ACA Marketplace; plans are typically HMO, PPO, EPO, or POS.
CEC ACA & Marketplace Fundamentals 2
Which federal agency oversees the Health Insurance Marketplace established under the ACA?