ACA Taxation Systems Regulatory
Framework Exam Questions and Answers
Verified Solutions Latest Update 2026/2027
Question:
ACA Gap Mitigation (Issues addressed)
Answer:
High uninsured rates, unaffordable coverage, pre-existing condition exclusions, and coverage
limits.
Question:
ACA Marketplaces (Exchanges)
Answer:
Organized markets where individuals and families can compare plans and receive financial
assistance.
Question:
On-exchange versus off-exchange plans
Answer:
They can be medically identical; the difference is where they are sold and whether subsidies apply.
Question:
Marketplace Eligibility and Coverage
Answer:
People without access to affordable employer coverage, Medicare, Medicaid, or CHIP.
Question:
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
Question:
EHBs constraints and benefit design
Answer:
Plans must cover all categories and be substantially equal to the state benchmark.
Question:
The state EHB benchmark plan
Answer:
A reference plan that defines the scope of EHBs in a state.
Question:
How do plans manage EHBs
Answer:
By shaping cost-sharing, limits, and definitions—not by excluding coverage.
Question:
Actuarial value (AV)
Answer:
, The average percentage of EHB costs paid by the plan for a standard population.
Question:
ACA metal tiers
Answer:
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
Question:
Purpose of metal tiers
Answer:
To standardize plan generosity and allow easier consumer comparison.
Question:
AV compliance
Answer:
All cost-sharing combined must fall within the metal tier's allowed AV range.
Question:
Cost-sharing
Answer:
The portion of health care costs members pay when using care.
Question:
Cost-sharing levers
Answer:
Deductibles, copays, coinsurance, OOP maximums, and pre/post-deductible design.
Framework Exam Questions and Answers
Verified Solutions Latest Update 2026/2027
Question:
ACA Gap Mitigation (Issues addressed)
Answer:
High uninsured rates, unaffordable coverage, pre-existing condition exclusions, and coverage
limits.
Question:
ACA Marketplaces (Exchanges)
Answer:
Organized markets where individuals and families can compare plans and receive financial
assistance.
Question:
On-exchange versus off-exchange plans
Answer:
They can be medically identical; the difference is where they are sold and whether subsidies apply.
Question:
Marketplace Eligibility and Coverage
Answer:
People without access to affordable employer coverage, Medicare, Medicaid, or CHIP.
Question:
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
Question:
EHBs constraints and benefit design
Answer:
Plans must cover all categories and be substantially equal to the state benchmark.
Question:
The state EHB benchmark plan
Answer:
A reference plan that defines the scope of EHBs in a state.
Question:
How do plans manage EHBs
Answer:
By shaping cost-sharing, limits, and definitions—not by excluding coverage.
Question:
Actuarial value (AV)
Answer:
, The average percentage of EHB costs paid by the plan for a standard population.
Question:
ACA metal tiers
Answer:
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
Question:
Purpose of metal tiers
Answer:
To standardize plan generosity and allow easier consumer comparison.
Question:
AV compliance
Answer:
All cost-sharing combined must fall within the metal tier's allowed AV range.
Question:
Cost-sharing
Answer:
The portion of health care costs members pay when using care.
Question:
Cost-sharing levers
Answer:
Deductibles, copays, coinsurance, OOP maximums, and pre/post-deductible design.
