NYSOH Assistors UPDATED ACTUAL Questions and
CORRECT Answers
What is the age limit for Child Health Plus? under 19
Are there co-pays and coinsurance or deductibles for No
CHP?
What is the income guidelines for CHP? no income limit, premium contribution varies on household size and FPL
What makes you ineligible for CHP? can't be eligible for Medicaid, can't have other insurance, don't have access to
or aren't enrolled in NYSHIP
What is the FPL of CHP for no premium? <160%
What is the QHP open enrollment period? November 1- January 31st
When QHP Enroll is completed, when does coverage Jan. 1
begin? Feb 1
Nov. 1-Dec. 15 March 1
Dec. 16- Jan 15
Jan 16-Jan 31
When are payments due for full pay QHP? consumers have a 10 day grace period for the first month and then 30 days
every month after
When are payments due for a subsidized QHP? consumers have a 10 day grace period for the first month and then 90 days
after that
What must quality rating include? effectiveness, access and availability of care, cost of care, use of frequency of
services, satisfaction
What features does a QHP has to have? Adequate networks, quality ratings
What does the Platinum, Gold, Silver and Bronze pay? Platinum 90-10
Gold 80-20
Silver 70-30
Bronze 60-40
What are the QHP deductibles for the metal levels? Platinum 0
Gold $600
Silver $2000
Bronze $4000
What must all insurance offer across all metal levels? same benefits, same cost sharing
How can Standard QHP's vary? premiums, provider networks, formularies and quality ratings
, What are the Eligibility for PTC and CSR Tax Filing consumers must attest that they will file taxes
requirements? if married, must file jointly unless they have a special exception
What are premium tax credits? Lower the cost of premiums, making health insurance more affordable
What is the FPL for PTCs? more than 200% and at or below 400% FPL
How can you help consumers choose a plan? 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? helps reduce out of pocket costs including co-pays, co-insurance, deductibles,
MOOP
What is Non Standard QHPs? has different networks, variations on cost sharing, additional benefits not
included in EHBs, limited substitutions in 2 benefit categories.
What is APTC reconciliation? 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 APTC recipients will receive a 1095A tax form from the Marketplace to
receive APTC? reconcile their APTC
What is the Medicaid enrollment period and when does enroll at any point in the year, coverage is effective back to the first of the
coverage begin? month from the date of application, through fee for service Medicaid
Who are considered NON-MAGI? 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? LDSS or HRA
What is the Medicaid Residency+ Citizenship/ Must be NYS residents, available to US citizens +Naturalized Citizens, Immigrant
Immigration Eligibility? Non-Citizens, Non- Immigrant Visa holders and other
What is MAGI for Medicaid based on? AGI, foreign earned income excluded from taxes, tax exempt interest, tax
exempt SSI
What are the Managed Care consumer costs? Some services have a co-pay like prescription drugs, co-pay maximum
$200/year
What population do not have co-pays for Medicaid? children under 21 and pregnant women
What are the tiered prescription co-pays for Medicaid? Brand name $3, Generic $1, over the counter .50
What is Medicaid Fee-For-Service? 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? 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? consumers who live in state psychiatric or residential treatment facilities or who
have other full benefit health insurance.
CORRECT Answers
What is the age limit for Child Health Plus? under 19
Are there co-pays and coinsurance or deductibles for No
CHP?
What is the income guidelines for CHP? no income limit, premium contribution varies on household size and FPL
What makes you ineligible for CHP? can't be eligible for Medicaid, can't have other insurance, don't have access to
or aren't enrolled in NYSHIP
What is the FPL of CHP for no premium? <160%
What is the QHP open enrollment period? November 1- January 31st
When QHP Enroll is completed, when does coverage Jan. 1
begin? Feb 1
Nov. 1-Dec. 15 March 1
Dec. 16- Jan 15
Jan 16-Jan 31
When are payments due for full pay QHP? consumers have a 10 day grace period for the first month and then 30 days
every month after
When are payments due for a subsidized QHP? consumers have a 10 day grace period for the first month and then 90 days
after that
What must quality rating include? effectiveness, access and availability of care, cost of care, use of frequency of
services, satisfaction
What features does a QHP has to have? Adequate networks, quality ratings
What does the Platinum, Gold, Silver and Bronze pay? Platinum 90-10
Gold 80-20
Silver 70-30
Bronze 60-40
What are the QHP deductibles for the metal levels? Platinum 0
Gold $600
Silver $2000
Bronze $4000
What must all insurance offer across all metal levels? same benefits, same cost sharing
How can Standard QHP's vary? premiums, provider networks, formularies and quality ratings
, What are the Eligibility for PTC and CSR Tax Filing consumers must attest that they will file taxes
requirements? if married, must file jointly unless they have a special exception
What are premium tax credits? Lower the cost of premiums, making health insurance more affordable
What is the FPL for PTCs? more than 200% and at or below 400% FPL
How can you help consumers choose a plan? 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? helps reduce out of pocket costs including co-pays, co-insurance, deductibles,
MOOP
What is Non Standard QHPs? has different networks, variations on cost sharing, additional benefits not
included in EHBs, limited substitutions in 2 benefit categories.
What is APTC reconciliation? 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 APTC recipients will receive a 1095A tax form from the Marketplace to
receive APTC? reconcile their APTC
What is the Medicaid enrollment period and when does enroll at any point in the year, coverage is effective back to the first of the
coverage begin? month from the date of application, through fee for service Medicaid
Who are considered NON-MAGI? 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? LDSS or HRA
What is the Medicaid Residency+ Citizenship/ Must be NYS residents, available to US citizens +Naturalized Citizens, Immigrant
Immigration Eligibility? Non-Citizens, Non- Immigrant Visa holders and other
What is MAGI for Medicaid based on? AGI, foreign earned income excluded from taxes, tax exempt interest, tax
exempt SSI
What are the Managed Care consumer costs? Some services have a co-pay like prescription drugs, co-pay maximum
$200/year
What population do not have co-pays for Medicaid? children under 21 and pregnant women
What are the tiered prescription co-pays for Medicaid? Brand name $3, Generic $1, over the counter .50
What is Medicaid Fee-For-Service? 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? 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? consumers who live in state psychiatric or residential treatment facilities or who
have other full benefit health insurance.
