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
What is a 'grandfathered' health plan under the ACA?
Answer: A plan that existed before the ACA was enacted and has not made significant benefit or cost changes
Grandfathered plans existed before March 23, 2010 (the ACA's enactment date), and are exempt from certain ACA requirements as long as they haven't made significant changes to coverage or cost-sharing.
What is the minimum actuarial value for an employer-sponsored plan to meet the ACA's 'minimum value' standard?
Answer: 60%
An employer plan must have an actuarial value of at least 60% to satisfy the minimum value requirement and protect employers from applicable ACA penalties.
What is a catastrophic health plan under the ACA?
Answer: A plan with very high deductibles available to those under 30 or with qualifying hardship exemptions
Catastrophic plans feature very high deductibles and are only available to individuals under age 30 or those with a qualifying hardship or affordability exemption.
Which of the following plans are required to cover all 10 Essential Health Benefits?
Answer: ACA Marketplace individual and small group plans
ACA Marketplace plans in the individual and small group markets must cover all 10 Essential Health Benefits as a condition of marketplace participation.
Under the ACA, the Essential Health Benefits benchmark for each state is typically based on:
Answer: The largest small group health plan by enrollment in the state
States select their EHB benchmark from approved options, most commonly the largest small group health plan by enrollment in that state, giving states some flexibility in defining EHBs.
Which of the following is covered under the 'preventive and wellness services' Essential Health Benefit?
Answer: Vaccinations recommended by the ACIP
Preventive and wellness services include ACIP-recommended vaccinations, preventive screenings, and counseling, all provided at no cost-sharing under ACA marketplace plans.
Which of the following best describes 'cost-sharing reductions' (CSRs) under the ACA?
Answer: Subsidies that lower deductibles and copays for Silver plan enrollees with qualifying incomes
CSRs reduce out-of-pocket costs such as deductibles, copays, and coinsurance for Silver plan enrollees with household incomes between 100% and 250% of the Federal Poverty Level.