ACA PRACTICE EXAMS ANSWERS AND QUESTIONS
SET A+
✔✔What were the big provisions of the ACA that started in 2014? - ✔✔• Essential
Benefits standardized and required for individual and small group plans sold through
exchanges (shopping in the Health Insurance Marketplace), insurers pay fees based on
market share, insurers can't restrict coverage or base premiums on health status or
gender, premium subsidies for middle-income exchange plan purchasers, individual and
employer mandates (delayed), insurance exchanges, Medicaid expansion
✔✔What's an example of a delay in the ACA requirements? - ✔✔• Individual and
employer mandates
✔✔What does Actuarial Value refer to? What are the metal levels? - ✔✔• Actuarial
value: a measure of the percentage of expected health care costs a health plan will
cover based on their standard population
• Metal levels: Bronze-60%, Silver-70%, Gold-80%, Platinum-90%
✔✔Why did the ACA support the development of insurance co-ops? - ✔✔• Non-profit
organizations get low interest loans to start new insurance plans owned by members on
a cooperative business model
• Supported because it is hard to get into the insurance market in the first place, and
they wanted to support start-ups
✔✔What are some of the ACA's impacts on state governments? - ✔✔• Medicaid
coverage expansion increases state spending
✔✔What is the expected net cost of the ACA over the next 10 years? - ✔✔• $1.35
trillion
✔✔What are the major expenditures under the ACA? - ✔✔• Exchange subsidies and
tax credits
• Medicaid/CHIP
• Small business tax credits
, ✔✔What are some examples of revenues generated by the ACA? - ✔✔• Uninsured
individuals' penalties
• Employer penalties
• Cadillac insurance tax
• New taxes and fees (higher Medicare tax on higher income people)
✔✔What are some ways that the ACA is supposed to save money (cut the deficit)? -
✔✔• Will lower deficit from spending offsets - reducing funding for Medicare Advantage
policies, reducing payments for uncompensated care and for preventable re-admissions
and hospital acquired infections, ACOs
✔✔Why are health costs/Medicare costs still expected to increase? - ✔✔• Aging of the
population, expansion of federal subsidies for health insurance, and rising health care
costs per person
✔✔What are Accountable Care Organizations and how will they save money and
improve care? - ✔✔• Groups of doctors, hospitals, and other health care providers who
come together to give coordinated care to their Medicare patients
• Incentives to coordinate care between providers for preventive care; care providers
make more decisions than insurers; patients have more freedom, can leave when they
want
✔✔What are some alternatives to "fee for service" payments? - ✔✔• Shared Savings
Program - ACO agrees to manage all of the health care needs of a minimum of 5,000
Medicare beneficiaries for at least 3 years
• Global Budgeting, capitation
• Shared savings (rewards) if they meet quality goals
✔✔How many more people are expected to gain insurance coverage as a result of the
ACA? By what means? - ✔✔• 90% of the population will be insured
• 16 million more on Medicaid and CHIP
• 24 million will get insurance through the exchanges
• 9 million fewer people on employer insurance
✔✔How many will remain uninsured, who are they likely to be, and why? - ✔✔• 29
million will be uninsured rather than 56 million
• Likely to be undocumented immigrants, people that have access but don't enroll, not
eligible for Medicaid because their state rejected expansion
✔✔What impact is the ACA expected to have on healthcare spending overall? - ✔✔•
Costs are still rising but will be slowing
✔✔What's the trend in healthcare spending and what is contributing to that trend? - ✔✔•
Healthcare spending is slowing
SET A+
✔✔What were the big provisions of the ACA that started in 2014? - ✔✔• Essential
Benefits standardized and required for individual and small group plans sold through
exchanges (shopping in the Health Insurance Marketplace), insurers pay fees based on
market share, insurers can't restrict coverage or base premiums on health status or
gender, premium subsidies for middle-income exchange plan purchasers, individual and
employer mandates (delayed), insurance exchanges, Medicaid expansion
✔✔What's an example of a delay in the ACA requirements? - ✔✔• Individual and
employer mandates
✔✔What does Actuarial Value refer to? What are the metal levels? - ✔✔• Actuarial
value: a measure of the percentage of expected health care costs a health plan will
cover based on their standard population
• Metal levels: Bronze-60%, Silver-70%, Gold-80%, Platinum-90%
✔✔Why did the ACA support the development of insurance co-ops? - ✔✔• Non-profit
organizations get low interest loans to start new insurance plans owned by members on
a cooperative business model
• Supported because it is hard to get into the insurance market in the first place, and
they wanted to support start-ups
✔✔What are some of the ACA's impacts on state governments? - ✔✔• Medicaid
coverage expansion increases state spending
✔✔What is the expected net cost of the ACA over the next 10 years? - ✔✔• $1.35
trillion
✔✔What are the major expenditures under the ACA? - ✔✔• Exchange subsidies and
tax credits
• Medicaid/CHIP
• Small business tax credits
, ✔✔What are some examples of revenues generated by the ACA? - ✔✔• Uninsured
individuals' penalties
• Employer penalties
• Cadillac insurance tax
• New taxes and fees (higher Medicare tax on higher income people)
✔✔What are some ways that the ACA is supposed to save money (cut the deficit)? -
✔✔• Will lower deficit from spending offsets - reducing funding for Medicare Advantage
policies, reducing payments for uncompensated care and for preventable re-admissions
and hospital acquired infections, ACOs
✔✔Why are health costs/Medicare costs still expected to increase? - ✔✔• Aging of the
population, expansion of federal subsidies for health insurance, and rising health care
costs per person
✔✔What are Accountable Care Organizations and how will they save money and
improve care? - ✔✔• Groups of doctors, hospitals, and other health care providers who
come together to give coordinated care to their Medicare patients
• Incentives to coordinate care between providers for preventive care; care providers
make more decisions than insurers; patients have more freedom, can leave when they
want
✔✔What are some alternatives to "fee for service" payments? - ✔✔• Shared Savings
Program - ACO agrees to manage all of the health care needs of a minimum of 5,000
Medicare beneficiaries for at least 3 years
• Global Budgeting, capitation
• Shared savings (rewards) if they meet quality goals
✔✔How many more people are expected to gain insurance coverage as a result of the
ACA? By what means? - ✔✔• 90% of the population will be insured
• 16 million more on Medicaid and CHIP
• 24 million will get insurance through the exchanges
• 9 million fewer people on employer insurance
✔✔How many will remain uninsured, who are they likely to be, and why? - ✔✔• 29
million will be uninsured rather than 56 million
• Likely to be undocumented immigrants, people that have access but don't enroll, not
eligible for Medicaid because their state rejected expansion
✔✔What impact is the ACA expected to have on healthcare spending overall? - ✔✔•
Costs are still rising but will be slowing
✔✔What's the trend in healthcare spending and what is contributing to that trend? - ✔✔•
Healthcare spending is slowing
