Affordable Care Act Basics Flashcards
7 cards from real CACS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Affordable Care Act Basics flashcards as text
Under the ACA, what is the maximum out-of-pocket limit for an individual in a Marketplace plan for plan year 2024?
Answer: $9,450
For 2024, the ACA out-of-pocket maximum for individual coverage is $9,450; once reached, the plan pays 100% of covered in-network costs.
Which federal agency administers the Health Insurance Marketplace (Healthcare.gov)?
Answer: Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS), within HHS, operates the federally facilitated Marketplace at Healthcare.gov.
A consumer's ACA plan covers an emergency visit at an out-of-network hospital. Under the ACA's essential health benefit rules, which statement is TRUE?
Answer: Plans must cover emergency services without prior authorization
The ACA requires all non-grandfathered plans to cover emergency services without prior authorization, even from out-of-network providers.
What does 'creditable coverage' mean in the context of the ACA and Special Enrollment Periods?
Answer: Prior health insurance that counts toward satisfying waiting periods
Creditable coverage refers to prior qualifying health coverage that may be used to satisfy enrollment requirements and avoid gaps triggering penalties.
Under the ACA, which of the following is NOT considered a minimum essential coverage (MEC) type?
Answer: A short-term limited-duration health plan
Short-term limited-duration plans are explicitly excluded from the definition of minimum essential coverage under the ACA.
What is the income threshold (as a percentage of the Federal Poverty Level) above which individuals are NOT eligible for Medicaid under standard ACA expansion rules for adults?
Answer: 133% FPL (effectively 138% with 5% disregard)
ACA Medicaid expansion covers adults up to 133% FPL; with the standard 5% income disregard, the effective threshold is 138% FPL.
A consumer wants to know if a specific drug is covered before enrolling in a Marketplace plan. Which plan document should the CAC direct them to review?
Answer: Plan Formulary
The plan formulary lists all covered prescription drugs and their tier-based cost-sharing, making it the correct resource for checking drug coverage.