Essential Health Benefits & Plan Types Flashcards
7 cards from real ACA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Essential Health Benefits & Plan Types flashcards as text
Which of the following is one of the 10 Essential Health Benefits mandated by the ACA?
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.
What is the actuarial value of a Gold plan under the ACA?
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.
Which metal tier has the HIGHEST actuarial value under the ACA?
Answer: Platinum
Platinum plans have the highest actuarial value of 90%, meaning insurers cover 90% of covered healthcare costs for a standard population.
What is the actuarial value of a Silver plan in the ACA marketplace?
Answer: 70%
Silver plans have an actuarial value of 70%, covering 70% of expected covered healthcare costs on average.
Which of the following is NOT one of the 10 Essential Health Benefits under the ACA?
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.
Which plan type is the basis for calculating Premium Tax Credits in the ACA marketplace?
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.
What is the actuarial value of a Bronze plan in the ACA marketplace?
Answer: 60%
Bronze plans have an actuarial value of 60%, providing the lowest coverage level but typically the lowest monthly premiums.