ACA TAXATION SYSTEMS AND
REGULATORY FRAMEWORK QUESTION
BANK 2026
◉ ACA Gap Mitigation (Issues addressed)
Answer: High uninsured rates, unaffordable coverage, pre-existing
condition exclusions, and coverage limits.
◉ ACA Marketplaces (Exchanges)
Answer: Organized markets where individuals and families can
compare plans and receive financial assistance.
◉ On-exchange versus off-exchange plans
Answer: They can be medically identical; the difference is where
they are sold and whether subsidies apply.
◉ Marketplace Eligibility and Coverage
Answer: People without access to affordable employer coverage,
Medicare, Medicaid, or CHIP.
◉ Essential Health Benefits (EHBs)
,Answer: Ten mandatory benefit categories required in ACA
individual and small-group plans.
1) Outpatient care
2) emergency
3) hospitalization
4) maternity/newborn
5) mental health/SUD
6) prescription drugs
7) rehab/habilitative
8) labs
9) preventive/chronic
10) pediatric dental/vision
◉ EHBs constraints and benefit design
Answer: Plans must cover all categories and be substantially equal
to the state benchmark.
◉ The state EHB benchmark plan
Answer: A reference plan that defines the scope of EHBs in a state.
◉ How do plans manage EHBs
, Answer: By shaping cost-sharing, limits, and definitions—not by
excluding coverage.
◉ Actuarial value (AV)
Answer: The average percentage of EHB costs paid by the plan for a
standard population.
◉ ACA metal tiers
Answer: Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
◉ Purpose of metal tiers
Answer: To standardize plan generosity and allow easier consumer
comparison.
◉ AV compliance
Answer: All cost-sharing combined must fall within the metal tier's
allowed AV range.
◉ Cost-sharing
REGULATORY FRAMEWORK QUESTION
BANK 2026
◉ ACA Gap Mitigation (Issues addressed)
Answer: High uninsured rates, unaffordable coverage, pre-existing
condition exclusions, and coverage limits.
◉ ACA Marketplaces (Exchanges)
Answer: Organized markets where individuals and families can
compare plans and receive financial assistance.
◉ On-exchange versus off-exchange plans
Answer: They can be medically identical; the difference is where
they are sold and whether subsidies apply.
◉ Marketplace Eligibility and Coverage
Answer: People without access to affordable employer coverage,
Medicare, Medicaid, or CHIP.
◉ Essential Health Benefits (EHBs)
,Answer: Ten mandatory benefit categories required in ACA
individual and small-group plans.
1) Outpatient care
2) emergency
3) hospitalization
4) maternity/newborn
5) mental health/SUD
6) prescription drugs
7) rehab/habilitative
8) labs
9) preventive/chronic
10) pediatric dental/vision
◉ EHBs constraints and benefit design
Answer: Plans must cover all categories and be substantially equal
to the state benchmark.
◉ The state EHB benchmark plan
Answer: A reference plan that defines the scope of EHBs in a state.
◉ How do plans manage EHBs
, Answer: By shaping cost-sharing, limits, and definitions—not by
excluding coverage.
◉ Actuarial value (AV)
Answer: The average percentage of EHB costs paid by the plan for a
standard population.
◉ ACA metal tiers
Answer: Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
◉ Purpose of metal tiers
Answer: To standardize plan generosity and allow easier consumer
comparison.
◉ AV compliance
Answer: All cost-sharing combined must fall within the metal tier's
allowed AV range.
◉ Cost-sharing
