Practice Test Geeks(CACs) Certified Application Counselor Practice Test
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Marketplace Plan Options 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 Marketplace Plan Options flashcards as text

  1. A 28-year-old single individual is in good health and wants a Marketplace plan with the lowest possible monthly premium. They understand that this means they will have a high deductible and will pay more for care when they need it. Which 'metal level' plan would be the most appropriate recommendation?

    Answer: Bronze

    Bronze plans are designed to have the lowest monthly premiums but the highest out-of-pocket costs, such as deductibles and copayments, when care is needed. This structure is suitable for healthy individuals who primarily want coverage for major accidents or illnesses.

  2. An applicant with a household income at 180% of the Federal Poverty Level (FPL) wants to receive financial assistance to lower their deductibles, copayments, and coinsurance. To receive these specific 'extra savings,' which type of Marketplace plan MUST they enroll in?

    Answer: A Silver plan

    Cost-Sharing Reductions (CSRs), often called 'extra savings,' are only available to eligible individuals who enroll in a Silver plan. These savings lower out-of-pocket costs like deductibles and copays for consumers with household incomes between 100% and 250% of the FPL.

  3. Which of the following is NOT considered one of the 10 Essential Health Benefits that all Marketplace plans are required to cover?

    Answer: Cosmetic surgery

    The Affordable Care Act (ACA) requires that all individual and small group plans, including those on the Marketplace, cover 10 Essential Health Benefits. These include categories like maternity care, prescription drugs, and mental health services. Cosmetic surgery that is not medically necessary is not an essential health benefit.

  4. A consumer loses their job-based health coverage on June 15th. They want to enroll in a Marketplace plan. This situation is known as a Qualifying Life Event (QLE), which triggers what opportunity for the consumer?

    Answer: A Special Enrollment Period (SEP)

    Losing other health coverage, such as from a job, is a Qualifying Life Event (QLE) that allows an individual to enroll in a new health plan outside of the regular Open Enrollment Period. This window of opportunity is called a Special Enrollment Period (SEP).

  5. A 35-year-old individual wants to purchase a Catastrophic health plan because of its very low premium. They do not qualify for a hardship or affordability exemption. As a Certified Application Counselor, what should you advise them?

    Answer: They are not eligible for a Catastrophic plan due to their age.

    Catastrophic plans are generally only available to individuals under the age of 30 or those who qualify for a hardship or affordability exemption. Since the individual is 35 and does not have an exemption, they are not eligible for this type of plan.

  6. A family is comparing a Health Maintenance Organization (HMO) plan and a Preferred Provider Organization (PPO) plan on the Marketplace. What is a key difference a CAC should explain to them?

    Answer: HMOs only cover services from in-network providers (except in emergencies), while PPOs offer some coverage for out-of-network care.

    A primary distinction between HMOs and PPOs is the provider network. HMOs typically limit coverage to care from in-network doctors and hospitals, except in emergencies. PPO plans provide more flexibility by offering coverage for both in-network and out-of-network providers, though out-of-pocket costs are higher for out-of-network care.