Healthcare Programs & Coverage Options 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 Healthcare Programs & Coverage Options flashcards as text
Which of the following consumers is eligible to purchase a Qualified Health Plan (QHP) through the Marketplace?
Answer: A lawfully present immigrant with income at 200% FPL
Lawfully present immigrants who meet income requirements and are not incarcerated or enrolled in Medicare are eligible for Marketplace QHPs.
The Small Business Health Options Program (SHOP) is designed for employers with how many employees?
Answer: 1–50 full-time equivalent employees
SHOP is available to employers with 1–50 full-time equivalent employees, allowing them to offer employees Marketplace coverage.
A consumer with income at 95% FPL in a non-Medicaid expansion state is applying for coverage. Which outcome is most likely?
Answer: They fall into the 'coverage gap' with no affordable options
In non-expansion states, adults below 100% FPL don't qualify for Medicaid expansion or Marketplace subsidies, leaving them in a coverage gap.
Under the ACA, preventive services with an 'A' or 'B' rating from the U.S. Preventive Services Task Force must be covered by non-grandfathered plans with:
Answer: No cost-sharing
Recommended preventive services rated A or B by the USPSTF must be covered at no cost to the patient in non-grandfathered plans.
When reconciling APTC at tax time, a consumer who received more APTC than they were entitled to (due to higher actual income) must:
Answer: Repay excess APTC, subject to repayment caps based on income
Consumers must repay excess APTC when filing taxes, but income-based repayment caps limit the maximum amount owed.
Which statement best describes 'Medicaid spend-down'?
Answer: A process where individuals with excess income can qualify for Medicaid by incurring medical expenses that reduce income to the eligibility level
Spend-down allows individuals whose income exceeds Medicaid limits to qualify once their medical expenses reduce their net income to the eligible level.
A consumer enrolling through the Federally Facilitated Marketplace (FFM) selects a Silver plan and qualifies for a cost-sharing reduction (CSR). What must a CAC tell them about CSRs?
Answer: CSRs are only available on Silver plans and reduce deductibles, copays, and coinsurance
CSRs are available exclusively on Silver plans and lower out-of-pocket costs such as deductibles, copays, and coinsurance for eligible enrollees.