HCMG EXAM QUESTIONS AND ANSWERS LATEST
EDITION ALREADY GRADED A+
What problem did the ACA address in the non-group insurance market
It addressed high premiums limited coverage and exclusions for pre-existing conditions that left many
uninsured
Explain the three-pronged approach of the ACA
It included insurance market reforms an individual mandate and financial assistance through Medicaid
expansion and subsidies
How did the ACA prevent insurers from denying coverage
The ACA implemented rules that prohibited insurers from denying coverage or charging higher
premiums based on pre-existing conditions
What is modified community rating under the ACA
Modified community rating allows premium adjustments based on age or tobacco use but prohibits
adjustments based on health status
Describe the purpose of the individual mandate under the ACA
The individual mandate required most Americans to have health insurance or face a tax penalty to
maintain a balanced insurance pool
What type of financial assistance does the ACA provide for low-income individuals
It expanded Medicaid coverage and offered subsidies on the exchanges to help cover premium and out-
of-pocket costs
Explain the ACA's Medicaid expansion
Medicaid expansion increased eligibility to individuals with incomes up to 138% of the federal poverty
level to cover more low-income adults
How do ACA subsidies work on the health insurance exchanges
Subsidies are available to individuals earning between 100-400% of the federal poverty level reducing
monthly premiums and out-of-pocket costs
What is the purpose of cost-sharing reductions (CSRs) under the ACA
CSRs lower out-of-pocket costs for low-income individuals purchasing silver plans on the exchanges
Describe the concept of silver loading
Silver loading increases premiums on silver plans which raises subsidy amounts because subsidies are
based on the cost of the second-lowest silver plan
What are the essential health benefits under the ACA
, The ACA requires insurance plans to cover ten essential health benefits including preventive care and
maternity services
How did the ACA affect employer-sponsored health insurance
Employers with 50 or more employees must offer affordable coverage or face penalties which expanded
employer-sponsored insurance
What age limit did the ACA set for dependents on family insurance plans
The ACA allows dependents to remain on their parents' insurance plan until age 26
What protections does the ACA provide for people with pre-existing conditions
It prohibits insurers from denying coverage or charging higher premiums based on pre-existing health
conditions
Explain the role of the health insurance marketplaces established by the ACA
Marketplaces allow individuals to compare and purchase insurance plans with available subsidies based
on income
What is the significance of actuarial value in ACA marketplace plans
Actuarial value indicates the percentage of healthcare costs the plan covers and helps consumers
compare plan generosity across metal tiers
How did the ACA change the medical loss ratio (MLR) requirements for insurers
The ACA requires insurers to spend 80-85% of premiums on healthcare costs and quality improvements
rather than administrative expenses
Explain the impact of the Supreme Court's decision on Medicaid expansion
The court ruled that states could opt out of Medicaid expansion without losing existing funding resulting
in varied expansion across states
What was the effect of removing the individual mandate penalty in 2019
Without the penalty fewer people were incentivized to buy insurance which increased the risk of
adverse selection in the insurance pool
How did the Trump administration change the ACA's implementation
It reduced funding for outreach shortened enrollment periods promoted short-term plans and removed
the individual mandate penalty
What impact did the Biden administration have on the ACA during the COVID-19 pandemic
The administration extended enrollment periods restored navigator funding and increased subsidies
under COVID relief
How did the American Rescue Plan Act enhance ACA subsidies
EDITION ALREADY GRADED A+
What problem did the ACA address in the non-group insurance market
It addressed high premiums limited coverage and exclusions for pre-existing conditions that left many
uninsured
Explain the three-pronged approach of the ACA
It included insurance market reforms an individual mandate and financial assistance through Medicaid
expansion and subsidies
How did the ACA prevent insurers from denying coverage
The ACA implemented rules that prohibited insurers from denying coverage or charging higher
premiums based on pre-existing conditions
What is modified community rating under the ACA
Modified community rating allows premium adjustments based on age or tobacco use but prohibits
adjustments based on health status
Describe the purpose of the individual mandate under the ACA
The individual mandate required most Americans to have health insurance or face a tax penalty to
maintain a balanced insurance pool
What type of financial assistance does the ACA provide for low-income individuals
It expanded Medicaid coverage and offered subsidies on the exchanges to help cover premium and out-
of-pocket costs
Explain the ACA's Medicaid expansion
Medicaid expansion increased eligibility to individuals with incomes up to 138% of the federal poverty
level to cover more low-income adults
How do ACA subsidies work on the health insurance exchanges
Subsidies are available to individuals earning between 100-400% of the federal poverty level reducing
monthly premiums and out-of-pocket costs
What is the purpose of cost-sharing reductions (CSRs) under the ACA
CSRs lower out-of-pocket costs for low-income individuals purchasing silver plans on the exchanges
Describe the concept of silver loading
Silver loading increases premiums on silver plans which raises subsidy amounts because subsidies are
based on the cost of the second-lowest silver plan
What are the essential health benefits under the ACA
, The ACA requires insurance plans to cover ten essential health benefits including preventive care and
maternity services
How did the ACA affect employer-sponsored health insurance
Employers with 50 or more employees must offer affordable coverage or face penalties which expanded
employer-sponsored insurance
What age limit did the ACA set for dependents on family insurance plans
The ACA allows dependents to remain on their parents' insurance plan until age 26
What protections does the ACA provide for people with pre-existing conditions
It prohibits insurers from denying coverage or charging higher premiums based on pre-existing health
conditions
Explain the role of the health insurance marketplaces established by the ACA
Marketplaces allow individuals to compare and purchase insurance plans with available subsidies based
on income
What is the significance of actuarial value in ACA marketplace plans
Actuarial value indicates the percentage of healthcare costs the plan covers and helps consumers
compare plan generosity across metal tiers
How did the ACA change the medical loss ratio (MLR) requirements for insurers
The ACA requires insurers to spend 80-85% of premiums on healthcare costs and quality improvements
rather than administrative expenses
Explain the impact of the Supreme Court's decision on Medicaid expansion
The court ruled that states could opt out of Medicaid expansion without losing existing funding resulting
in varied expansion across states
What was the effect of removing the individual mandate penalty in 2019
Without the penalty fewer people were incentivized to buy insurance which increased the risk of
adverse selection in the insurance pool
How did the Trump administration change the ACA's implementation
It reduced funding for outreach shortened enrollment periods promoted short-term plans and removed
the individual mandate penalty
What impact did the Biden administration have on the ACA during the COVID-19 pandemic
The administration extended enrollment periods restored navigator funding and increased subsidies
under COVID relief
How did the American Rescue Plan Act enhance ACA subsidies
