NYSOH ASSISTORS TEST EXAM QUESTIONS AND
ANSWERS| LATEST UPDATES 2027|
What is the FPL for PTCs? - ANSWER -more than 200% and at or below 400%
FPL
How can you help consumers choose a plan? - ANSWER -help consumers identify
priorities
help consumers use marketplace tools to narrow down plan options
help consumers enroll in a plan
What is Cost Sharing Reduction? - ANSWER -helps reduce out of pocket costs
including co-pays, co-insurance, deductibles, MOOP
What is Non Standard QHPs? - ANSWER -has different networks, variations on
cost sharing, additional benefits not included in EHBs, limited substitutions in 2
benefit categories.
What is APTC reconciliation? - ANSWER -consumers who receive APTC must
report all life events, such as change in household size, income, or job related
insurance
What will people receive at the end of year who receive APTC? - ANSWER -
APTC recipients will receive a 1095A tax form from the Marketplace to reconcile
their APTC
What is the Medicaid enrollment period and when does coverage begin? -
ANSWER -enroll at any point in the year, coverage is effective back to the first of
the month from the date of application, through fee for service Medicaid
Who are considered NON-MAGI? - ANSWER -Adults who are 65 or older and
not a parent or caretaker relative
Anyone who requires nursing care facility services, congregate care level 1,2 or 3,
waiver services, Medicaid buy in for working people with disabilities
, Who are Non-MAGI referred to? - ANSWER -LDSS or HRA
What is the Medicaid Residency+ Citizenship/ Immigration Eligibility? -
ANSWER -Must be NYS residents, available to US citizens +Naturalized Citizens,
Immigrant Non-Citizens, Non- Immigrant Visa holders and other
What is MAGI for Medicaid based on? - ANSWER -AGI, foreign earned income
excluded from taxes, tax exempt interest, tax exempt SSI
What are the Managed Care consumer costs? - ANSWER -Some services have a
co-pay like prescription drugs, co-pay maximum $200/year
What population do not have co-pays for Medicaid? - ANSWER -children under
21 and pregnant women
What are the tiered prescription co-pays for Medicaid? - ANSWER -Brand name
$3, Generic $1, over the counter .50
What is Medicaid Fee-For-Service? - ANSWER -they do not have to choose a
Managed care plan, and can go to any doctor or clinic that takes Medicaid
Who is Exempt from Medicaid-Fee-For-Service? - ANSWER -American Indians,
consumers in Long term alcohol or drug residential programs can choose FFS or a
managed care plan.
Who are excluded from Medicaid Fee For Service? - ANSWER -consumers who
live in state psychiatric or residential treatment facilities or who have other full
benefit health insurance.
What is Medicaid Health Insurance Premium Payment Program (HIIP) -
ANSWER -when a consumer enters their Employer Sponsored Insurance
Information(including the coverage start and end dates and the cost of the
coverage) into the application and uploads documentation, a referral is
automatically generated to evaluate for the HIIP program
ANSWERS| LATEST UPDATES 2027|
What is the FPL for PTCs? - ANSWER -more than 200% and at or below 400%
FPL
How can you help consumers choose a plan? - ANSWER -help consumers identify
priorities
help consumers use marketplace tools to narrow down plan options
help consumers enroll in a plan
What is Cost Sharing Reduction? - ANSWER -helps reduce out of pocket costs
including co-pays, co-insurance, deductibles, MOOP
What is Non Standard QHPs? - ANSWER -has different networks, variations on
cost sharing, additional benefits not included in EHBs, limited substitutions in 2
benefit categories.
What is APTC reconciliation? - ANSWER -consumers who receive APTC must
report all life events, such as change in household size, income, or job related
insurance
What will people receive at the end of year who receive APTC? - ANSWER -
APTC recipients will receive a 1095A tax form from the Marketplace to reconcile
their APTC
What is the Medicaid enrollment period and when does coverage begin? -
ANSWER -enroll at any point in the year, coverage is effective back to the first of
the month from the date of application, through fee for service Medicaid
Who are considered NON-MAGI? - ANSWER -Adults who are 65 or older and
not a parent or caretaker relative
Anyone who requires nursing care facility services, congregate care level 1,2 or 3,
waiver services, Medicaid buy in for working people with disabilities
, Who are Non-MAGI referred to? - ANSWER -LDSS or HRA
What is the Medicaid Residency+ Citizenship/ Immigration Eligibility? -
ANSWER -Must be NYS residents, available to US citizens +Naturalized Citizens,
Immigrant Non-Citizens, Non- Immigrant Visa holders and other
What is MAGI for Medicaid based on? - ANSWER -AGI, foreign earned income
excluded from taxes, tax exempt interest, tax exempt SSI
What are the Managed Care consumer costs? - ANSWER -Some services have a
co-pay like prescription drugs, co-pay maximum $200/year
What population do not have co-pays for Medicaid? - ANSWER -children under
21 and pregnant women
What are the tiered prescription co-pays for Medicaid? - ANSWER -Brand name
$3, Generic $1, over the counter .50
What is Medicaid Fee-For-Service? - ANSWER -they do not have to choose a
Managed care plan, and can go to any doctor or clinic that takes Medicaid
Who is Exempt from Medicaid-Fee-For-Service? - ANSWER -American Indians,
consumers in Long term alcohol or drug residential programs can choose FFS or a
managed care plan.
Who are excluded from Medicaid Fee For Service? - ANSWER -consumers who
live in state psychiatric or residential treatment facilities or who have other full
benefit health insurance.
What is Medicaid Health Insurance Premium Payment Program (HIIP) -
ANSWER -when a consumer enters their Employer Sponsored Insurance
Information(including the coverage start and end dates and the cost of the
coverage) into the application and uploads documentation, a referral is
automatically generated to evaluate for the HIIP program
