Covered California and the Affordable Care Act on the exam

Eight Accident & Health questions cover the ACA, and CDI's objectives give the exact income thresholds and percentages they draw on.

Questions and answers, explained

All 12 questions above, with the correct answer and why it is correct. Everything here is on covered california and the affordable care act on the exam.

1. Under the Affordable Care Act's MAGI rules in California, adults age 19 through 64 may qualify for Medi-Cal with household income up to what level?

   • A400 percent of the federal poverty level
   • B138 percent of the federal poverty levelCorrect
   • C100 percent of the federal poverty level
   • D266 percent of the federal poverty level

   Why: CDI's objectives state that adults 19 through 64 qualify for Medi-Cal with household income up to 138 percent of FPL, and children under 19 up to 266 percent of FPL.

   Reference PPACA; CA A&H objectives III.C.2.a

2. Up to what household income may children under 19 qualify for Medi-Cal under California's MAGI rules?

   • A250 percent of the federal poverty level
   • B138 percent of the federal poverty level
   • C266 percent of the federal poverty levelCorrect
   • DAny income, with no limit for children

   Why: Children under 19 qualify for Medi-Cal with household income up to 266 percent of FPL, a higher threshold than the 138 percent that applies to adults 19 through 64.

   Reference PPACA; CA A&H objectives III.C.2.a.ii

3. Under California's objectives, consumers may qualify for cost-sharing reductions with household income in which range?

   • ABetween 138 and 250 percent of the federal poverty levelCorrect
   • BAbove 400 percent of the federal poverty level
   • CBetween 250 and 400 percent of the federal poverty level, the same range as tax credits
   • DBelow 100 percent of the federal poverty level only

   Why: Cost-sharing reductions lower deductibles, copays and out-of-pocket maximums for eligible consumers with income between 138 and 250 percent of FPL who enroll in a Silver plan through Covered California.

   Reference PPACA section 1402; CA A&H objectives III.C.2.b

4. How are Advance Premium Tax Credits handled for Californians who buy coverage through Covered California?

   • AThe agent calculates them and deducts them from the agent's commission each month
   • BThey are available to anyone regardless of income
   • CThey are paid only as a refund three years later
   • DCovered California calculates them, and they are paid to the insurer to lower the premiumCorrect

   Why: APTCs may be available to households with income not more than 400 percent of FPL; they are calculated by the California Health Benefit Exchange (Covered California) and paid by the Exchange to insurers. A consumer must buy a qualified health plan through Covered California to receive them.

   Reference PPACA section 1401; CA A&H objectives III.C.2.d, III.C.5.a

5. A California consumer wants to use federal premium tax credits. Where must she buy her qualified health plan?

   • AThrough Medi-Cal
   • BThrough Covered CaliforniaCorrect
   • CThrough her employer's COBRA administrator
   • DDirectly from any insurer licensed in California, even off the exchange

   Why: Premium tax credits are available only for qualified health plans bought through the state exchange, Covered California. A plan bought directly from an insurer off the exchange is not eligible for them.

   Reference CA A&H objectives III.C.5.a

6. Under the ACA, new individual and group health policies in California are:

   • AGuaranteed issueCorrect
   • BAvailable only to people under 65
   • COptional for insurers to offer
   • DFully medically underwritten, so applicants with preexisting conditions may be declined

   Why: The ACA made health insurance guaranteed issue: insurers must accept applicants for new individual and group policies regardless of health status, though individual enrollment is limited to open enrollment and special enrollment periods.

   Reference PPACA; CA A&H objectives III.C.2.c

7. A Californian loses employer coverage in July and wants an individual plan. Why can she enroll outside open enrollment?

   • AOnly if she pays a late enrollment penalty
   • BShe must wait until the next open enrollment period
   • CLosing coverage is a qualifying event that opens a special enrollment periodCorrect
   • DAnyone may enroll at any time of year, because individual plans have no enrollment windows at all

   Why: Outside the annual open enrollment period, individuals may enroll only during a special enrollment period triggered by a qualifying life event, such as losing other coverage, marriage, birth or adoption, or moving.

   Reference PPACA; CA A&H objectives III.C.3.e-f

8. Which ACA metal tier has an actuarial value of about 70 percent, meaning the plan pays about 70 percent of covered costs on average?

   • AGold
   • BPlatinum
   • CBronze
   • DSilverCorrect

   Why: The metal tiers' actuarial values are about 60 percent for Bronze, 70 percent for Silver, 80 percent for Gold and 90 percent for Platinum. Cost-sharing reductions are available only on Silver plans.

   Reference PPACA section 1302(d); CA A&H objectives III.C.3.h, III.C.4.b.i

9. A healthy young adult wants the lowest monthly premium and accepts paying most costs himself until he meets a high deductible. Which metal tier fits best?

   • ASilver with cost-sharing reductions
   • BBronzeCorrect
   • CPlatinum, because it has the highest premium and therefore the lowest out-of-pocket costs
   • DGold

   Why: Bronze plans pay about 60 percent of covered costs on average, so they have the lowest premiums and the highest out-of-pocket costs. Platinum is the reverse.

   Reference CA A&H objectives III.C.3.h

10. In California individual and small group plans, which benefit is mandatory rather than optional?

    • ALong-term custodial care
    • BCosmetic surgery
    • CAdult dental and adult vision benefits, which every plan must include at no extra cost
    • DPediatric dental and vision benefitsCorrect

    Why: Pediatric dental and vision are part of the essential health benefits and are mandatory; adult dental and adult vision are optional coverages. The EHBs also include maternity, mental health and substance use, prescription drugs and preventive care.

    Reference PPACA section 1302; CA A&H objectives III.A.1.c

11. What is the difference between a Qualified Health Plan and Minimum Essential Coverage?

    • AA QHP is an exchange-certified plan; MEC is any coverage that meets the ACA's coverage requirementCorrect
    • BA QHP covers only preventive care
    • CThey are the same thing; both terms describe any plan an insurer sells
    • DMEC is sold only through Covered California

    Why: A Qualified Health Plan is certified by an exchange such as Covered California and meets its standards, including the essential health benefits and metal-tier actuarial values. Minimum Essential Coverage is the broader category of coverage that satisfies the coverage requirement, such as employer plans, Medicare, Medi-Cal and QHPs.

    Reference PPACA; CA A&H objectives III.C.4

12. Under the ACA, until what age may a child stay on a parent's individual or group health policy?

    • AAge 30, but only if unmarried
    • BAge 18, or age 23 if the child stays enrolled in college full time
    • CThrough the 26th birthday, or longer if he qualifies as a disabled dependentCorrect
    • DAge 21

    Why: CDI's objectives state that a child may be covered under a parent's policy through the 26th birthday, or longer if the child qualifies as a disabled dependent. A child who ages out of a group plan may continue under COBRA for up to 36 months.

    Reference PPACA; CA A&H objectives III.C.6

Drill the whole domain

• The Patient Protection and Affordable Care Act (5.3%)

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• California group health insurance, COBRA and Cal-COBRA
• California's Commissioner, unfair practices and the guarantee association
• Annuities for the California life exam

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