Essential Health Benefits & Plan Types Flashcards

Which of the following is an Essential Health Benefit mandated by the ACA?

Answer: Prescription drug coverage

Prescription drugs are one of the 10 mandated EHBs; alternative medicine, long-term care, and adult vision care are not required EHBs.

What does an HMO (Health Maintenance Organization) typically require of its members?

Answer: Choosing a primary care physician and obtaining referrals for specialists

HMOs require members to select a primary care physician (PCP) who coordinates care and must provide referrals for specialist visits to be covered.

What best describes an Exclusive Provider Organization (EPO)?

Answer: A plan that only covers in-network care except in emergencies

EPOs restrict coverage to in-network providers except for emergency care, but unlike HMOs, they typically do not require specialist referrals.

What does 'actuarial value' represent in an ACA health plan?

Answer: The percentage of total covered healthcare costs the plan pays on average

Actuarial value is the percentage of total covered healthcare expenses that the plan pays for a standard population of enrollees.

Which plan type typically offers the MOST provider flexibility but usually has higher monthly premiums?

Answer: PPO

PPOs allow members to see any provider, including out-of-network providers, without a referral, offering the most flexibility at typically higher premium costs.

A Health Savings Account (HSA) can be used in conjunction with which type of ACA health plan?

Answer: An HSA-qualified High-Deductible Health Plan (HDHP)

HSAs are only available to individuals enrolled in IRS-qualified HDHPs that meet the minimum deductible and maximum out-of-pocket thresholds set by the IRS.

What is the primary advantage of a Bronze plan for a relatively healthy individual?

Answer: Lower monthly premiums

Bronze plans offer the lowest monthly premiums of all metal tiers, making them cost-effective for individuals who rarely use healthcare services.