Health Coverage Programs 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 Health Coverage Programs flashcards as text
A consumer is 67 years old, receiving Medicare, and has income at 150% FPL. Which program might help pay their Medicare cost-sharing?
Answer: A Medicare Savings Program (MSP)
Medicare Savings Programs help low-income Medicare beneficiaries pay premiums, deductibles, and cost-sharing for Medicare — they are not eligible for Marketplace plans when enrolled in Medicare.
What is the maximum out-of-pocket (MOOP) limit designed to protect?
Answer: The consumer from unlimited cost-sharing in a plan year
The MOOP cap limits how much a consumer pays in cost-sharing (deductibles, copays, coinsurance) in a plan year; after reaching it, the plan covers 100% of covered costs.
A lawfully present immigrant who has been in the U.S. for less than 5 years may be eligible for which program despite the standard 5-year bar?
Answer: Emergency Medicaid only in most states
Most lawfully present immigrants must wait 5 years before qualifying for full Medicaid, but Emergency Medicaid (covering emergency medical conditions) is available regardless of the waiting period.
Which ACA provision requires most Americans to have health coverage or potentially face a tax penalty at the federal level?
Answer: The individual shared responsibility provision
The individual shared responsibility provision (individual mandate) originally required most Americans to maintain MEC or pay a federal penalty, though the federal penalty was reduced to $0 starting in 2019.
Essential Health Benefits (EHBs) must be covered by which types of plans?
Answer: Individual and small group plans inside and outside the Marketplace
ACA requires individual and small group health insurance plans — both inside and outside the Marketplace — to cover the ten categories of Essential Health Benefits.
A consumer loses their job on March 15. How long do they typically have to elect COBRA continuation coverage?
Answer: 60 days from notice of COBRA rights
COBRA law gives qualified beneficiaries 60 days from the date of the COBRA election notice (or loss of coverage, whichever is later) to elect continuation coverage.
Which Marketplace plan type generally has the lowest monthly premium but the highest out-of-pocket costs when care is used?
Answer: Bronze
Bronze plans have the lowest actuarial value (~60%), meaning consumers pay more when they use care, but these plans carry the lowest monthly premiums.