ACA TEST EVALUATION ANSWERS AND QUESTIONS
SET A+
✔✔How does the employer mandate work? Enforcement? Penalties? What triggers a
penalty? - ✔✔• Penalties are triggered if they have at least one full-time employee using
premium tax credits to buy insurance through an exchange
✔✔What is a grandfathered plan? - ✔✔• Employer and individual plans in existence at
time of ACA
✔✔What's the ACA's rule on young people? - ✔✔• Can stay on parents' insurance plan
until age 26
✔✔How does the ACA restrict how insurance companies choose who they cover? -
✔✔• Ban on denying insurance to children with pre-existing conditions
• Ban on rescission and lifetime caps
✔✔How does the ACA restrict what insurance companies cover? - ✔✔• Must cover 10
essential benefits
• Provide minimum actuarial value and maximum out-of-pocket costs
✔✔What information about insurance applicants can insurance companies use in
setting premium prices? - ✔✔• Geography, family size, age, tobacco use
• CANNOT set prices based on gender or health status
✔✔How does the ACA restrict how much insurance companies take for profit and
administration? - ✔✔• Set MLR at 80/20, meaning that 80% must be used for insurance,
20% can be used elsewhere
✔✔What is "rescission" and what does the ACA say about it? - ✔✔• Rescission is
kicking people off/dropping the sick from an insurance plan. The ACA bans it.
, ✔✔What's the medical loss ratio rules? - ✔✔• Amount of money spent on clinical
services and quality improvement - pay it or rebate it, meaning that they reimburse the
customer if they fail
✔✔How does the ACA support access to primary care other than through insurance
access? - ✔✔• Loans given to primary care, pediatrics, and nursing students
• Funding to community health centers and NHS for clinicians for the underserved
• Medicare increases primary care payments
✔✔What are some ways that the ACA tries to provide healthcare consumers with more
information with which to make decisions? - ✔✔• Summary of benefits and coverage
• Hospital Compare (2012)
• Physician Compare (2010)
✔✔What is the Summary of Benefits and Coverage and what is included? - ✔✔• Clear
standardized information that includes your costs for common medical services,
services not included in your coverage, coverage examples, standard definitions for
insurance and medical terms, your right (to continue coverage, how to complain),
contact information for company or plan
✔✔What are Essential Benefits? - ✔✔• Ambulatory patient services, emergency
services, hospitalization, maternity and newborn care, mental health and substance use
disorder services, including behavioral health treatment, prescription drugs,
rehabilitative and habilitative services and devices, laboratory services, preventive
wellness services and chronic disease management, and pediatric services, including
oral and vision care
✔✔How does the ACA help women with regard to reproductive health care? - ✔✔•
Can't discriminate on basis of gender
• New plans must cover and eliminate cost-sharing for recommended preventive
services and screenings
• Medicaid expanding means more women have access to family planning
• Some states have plans that include abortion coverage
✔✔How is abortion coverage by insurance handled in the exchanges? - ✔✔• No federal
funds for abortions, but it is determined by the state. Some have coverage through the
marketplace, while other have no plan offering coverage
✔✔What is an example of how the ACA tries to improve healthcare outcomes and
quality? - ✔✔• Medicare launches "Accountable Care Organization" incentives
• Providers form HMO-style groups that aim to improve quality while lowering costs
through coordination
SET A+
✔✔How does the employer mandate work? Enforcement? Penalties? What triggers a
penalty? - ✔✔• Penalties are triggered if they have at least one full-time employee using
premium tax credits to buy insurance through an exchange
✔✔What is a grandfathered plan? - ✔✔• Employer and individual plans in existence at
time of ACA
✔✔What's the ACA's rule on young people? - ✔✔• Can stay on parents' insurance plan
until age 26
✔✔How does the ACA restrict how insurance companies choose who they cover? -
✔✔• Ban on denying insurance to children with pre-existing conditions
• Ban on rescission and lifetime caps
✔✔How does the ACA restrict what insurance companies cover? - ✔✔• Must cover 10
essential benefits
• Provide minimum actuarial value and maximum out-of-pocket costs
✔✔What information about insurance applicants can insurance companies use in
setting premium prices? - ✔✔• Geography, family size, age, tobacco use
• CANNOT set prices based on gender or health status
✔✔How does the ACA restrict how much insurance companies take for profit and
administration? - ✔✔• Set MLR at 80/20, meaning that 80% must be used for insurance,
20% can be used elsewhere
✔✔What is "rescission" and what does the ACA say about it? - ✔✔• Rescission is
kicking people off/dropping the sick from an insurance plan. The ACA bans it.
, ✔✔What's the medical loss ratio rules? - ✔✔• Amount of money spent on clinical
services and quality improvement - pay it or rebate it, meaning that they reimburse the
customer if they fail
✔✔How does the ACA support access to primary care other than through insurance
access? - ✔✔• Loans given to primary care, pediatrics, and nursing students
• Funding to community health centers and NHS for clinicians for the underserved
• Medicare increases primary care payments
✔✔What are some ways that the ACA tries to provide healthcare consumers with more
information with which to make decisions? - ✔✔• Summary of benefits and coverage
• Hospital Compare (2012)
• Physician Compare (2010)
✔✔What is the Summary of Benefits and Coverage and what is included? - ✔✔• Clear
standardized information that includes your costs for common medical services,
services not included in your coverage, coverage examples, standard definitions for
insurance and medical terms, your right (to continue coverage, how to complain),
contact information for company or plan
✔✔What are Essential Benefits? - ✔✔• Ambulatory patient services, emergency
services, hospitalization, maternity and newborn care, mental health and substance use
disorder services, including behavioral health treatment, prescription drugs,
rehabilitative and habilitative services and devices, laboratory services, preventive
wellness services and chronic disease management, and pediatric services, including
oral and vision care
✔✔How does the ACA help women with regard to reproductive health care? - ✔✔•
Can't discriminate on basis of gender
• New plans must cover and eliminate cost-sharing for recommended preventive
services and screenings
• Medicaid expanding means more women have access to family planning
• Some states have plans that include abortion coverage
✔✔How is abortion coverage by insurance handled in the exchanges? - ✔✔• No federal
funds for abortions, but it is determined by the state. Some have coverage through the
marketplace, while other have no plan offering coverage
✔✔What is an example of how the ACA tries to improve healthcare outcomes and
quality? - ✔✔• Medicare launches "Accountable Care Organization" incentives
• Providers form HMO-style groups that aim to improve quality while lowering costs
through coordination
