Chapter 13 - Federal Patient Protection and Affordable Care Act

Question 1

What is the maximum age for qualifying for a catastrophic plan?

Answer 1

Age 30 - Young adults under age 30 and individuals who cannot obtain affordable coverage (have hardship exemption) may be able to purchase individual catastrophic plans that cover essential benefits.

Question 2

According to the Medical Loss Ration (MLR), what is the minimum percentage of health coverage premium that must be applied to actual medical care in individual health plans and small group markets?

Answer 2

80%

Question 3

According to the Medical Loss Ration (MLR), what is the minimum percentage of health coverage premium that must be applied to actual medical care in large group markets?

Answer 3

85%

Question 4

When is the annual open enrollment for state insurance exchanges?

Answer 4

November 1st through January 31st.

Question 5

Under the ACA, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event?

Answer 5

60 days from the date of a triggering event.

Question 6

Under the ACA, what percentage of preventative care must be covered without cost-sharing?

Answer 6

100%

Question 7

What percentage of expected health care costs do each of the metal level classifications of plans cover?

Answer 7

Bronze - 60%
Silver - 70%
Gold - 80%
Platinum - 90%

Question 8

What are the requirements for an individual to eligible for health coverage on the Marketplace? (4)

Answer 8

• Individual must be US Citizen or national or be lawfully present in the US
• Must live in the US
• Cannot be currently incarcerated
• Medicare recipients are not eligible for coverage