Marketplace Plan 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 Marketplace Plan Options flashcards as text
A consumer wants to keep seeing their current doctor who is only in-network for one specific plan. Which Marketplace tool should a CAC use to help verify provider participation?
Answer: The plan's provider directory or network search tool
Each insurer's provider directory or online network search tool shows which doctors and facilities are in-network for a specific plan.
Which statement about Marketplace plan formularies is accurate?
Answer: Each plan has its own formulary, and drug coverage and cost-sharing can vary significantly between plans
Each insurer sets its own formulary, so the drugs covered and their tier-based cost-sharing can differ substantially between plans even within the same metal tier.
When comparing two Silver plans with identical premiums, what should a CAC help a client with high expected medical utilization focus on?
Answer: Which plan has the lowest out-of-pocket maximum and deductible
A high-utilization client will likely reach their deductible and out-of-pocket maximum, so lower cost-sharing limits directly reduce their total annual health spending.
Under the ACA, what is the maximum number of metal tier plans a consumer can enroll in simultaneously through the Marketplace?
Answer: One
A consumer can only be enrolled in one Marketplace Qualified Health Plan at a time, though they may also enroll in a separate stand-alone dental plan.
A client moves to a new state mid-year. How does this affect their Marketplace plan?
Answer: They must re-enroll in a new plan in their new state's Marketplace during a Special Enrollment Period
Moving to a new state triggers a Special Enrollment Period, and the consumer must enroll in a new Marketplace plan in their new state of residence.
Which of the following is NOT typically considered an Essential Health Benefit under the ACA?
Answer: Elective cosmetic surgery
Elective cosmetic surgery is not among the 10 Essential Health Benefits mandated by the ACA for Marketplace plans.
A CAC is helping a client compare a Bronze HMO and a Gold PPO. The client has a tight monthly budget but anticipates needing frequent specialist visits. What is the BEST advice?
Answer: Consider whether the higher Gold PPO premium may be offset by lower specialist cost-sharing and no referral requirements
For a client with frequent specialist needs, higher premiums in a Gold PPO may be offset by lower cost-sharing per visit and the flexibility to see specialists without referrals.