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
Which federal program provides health coverage to people with end-stage renal disease (ESRD) regardless of age?
Answer: Medicare
Medicare covers individuals with ESRD regardless of age because it is a specific eligibility pathway under Medicare Part A and Part B.
Under the ACA, which metal tier plan covers approximately 90% of average healthcare costs?
Answer: Platinum
Platinum plans have the highest actuarial value at approximately 90%, meaning the plan covers about 90% of average covered costs.
A family's Modified Adjusted Gross Income (MAGI) is used to determine eligibility for which programs?
Answer: Marketplace plans and Medicaid
MAGI-based income rules apply to Marketplace coverage, premium tax credits, cost-sharing reductions, Medicaid, and CHIP eligibility determinations.
What is the purpose of a Special Enrollment Period (SEP)?
Answer: To permit enrollment outside the standard Open Enrollment Period due to a qualifying life event
SEPs allow consumers who experience qualifying life events — such as losing coverage, marriage, or moving — to enroll in a health plan outside Open Enrollment.
Which program offers coverage to children in families that earn too much for Medicaid but cannot afford private insurance?
Answer: CHIP
CHIP (Children's Health Insurance Program) fills the coverage gap for children in families whose income exceeds Medicaid limits but is still low enough to qualify for subsidized coverage.
What is an actuarial value (AV) in the context of Marketplace metal tiers?
Answer: The percentage of total average costs a plan covers for a standard population
Actuarial value represents the average percentage of covered medical costs the plan pays for a standard population, determining the metal tier classification.
Which of the following is NOT a qualifying life event that triggers a Special Enrollment Period?
Answer: Voluntarily dropping existing coverage
Voluntarily dropping coverage is not a qualifying life event; SEPs are triggered by involuntary loss of coverage or significant life changes, not personal choice to disenroll.