Affordable Care Act Basics Flashcards
6 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 6 Affordable Care Act Basics flashcards as text
A consumer loses their employer-sponsored health coverage. Under the Affordable Care Act, this event typically triggers a:
Answer: Special Enrollment Period (SEP)
Losing job-based health insurance is considered a Qualifying Life Event (QLE), which makes an individual eligible for a Special Enrollment Period (SEP). This allows them to enroll in a new health plan through the Marketplace outside of the annual Open Enrollment Period.
Which of the following is a key role of a Certified Application Counselor (CAC)?
Answer: Helping consumers understand their eligibility for Marketplace plans, Medicaid, and CHIP.
The primary role of a CAC is to provide fair, impartial, and accurate information to help consumers understand their options and assist them with the application process for Marketplace coverage, Medicaid, and the Children's Health Insurance Program (CHIP). They are not permitted to sell insurance or recommend specific plans.
Under the ACA, what is the primary purpose of the Advanced Premium Tax Credit (APTC)?
Answer: To lower the monthly health insurance premium for eligible individuals and families.
The Advanced Premium Tax Credit (APTC) is a subsidy the federal government pays directly to the insurance company to lower the consumer's monthly premium for plans purchased through the Health Insurance Marketplace.
A 28-year-old single adult with an annual income of 130% of the Federal Poverty Level (FPL) lives in a state that has expanded Medicaid. Which program are they most likely eligible for?
Answer: Medicaid
The ACA allows states to expand Medicaid to cover most low-income adults under age 65 with household incomes up to 138% of the FPL. In a state that has adopted expansion, this individual's income would make them eligible for Medicaid.
Which of the following is a fundamental requirement for an individual to be eligible to enroll in a Qualified Health Plan through the Health Insurance Marketplace?
Answer: They must not be incarcerated.
To be eligible to enroll in health coverage through the Marketplace, an individual must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated. Individuals enrolled in Medicare are not eligible to purchase a Marketplace plan.
Under the Affordable Care Act, most health plans must cover certain preventive services at no cost to the consumer. This means:
Answer: The consumer does not have to pay a copayment, coinsurance, or deductible for these services when received from an in-network provider.
The ACA requires most private health plans to cover a list of preventive services without any cost-sharing (copay, coinsurance, or deductible) when these services are delivered by a provider in the plan's network.