PY 2025 Pennie Individual Marketplace Training for
New Agents and Brokers ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+
What is the primary goal of the ACA - CORRECT ANSWER
Provides a premium tax credit (PTC) to help subsidize coverage.
Gives consumers tools to make informed choices about their
healthcare coverage.
Puts in place strong consumer protections
The ACA makes care more accessible by - CORRECT ANSWER 1
- Creating the Health Insurance Marketplace
2 - Provided qualified Individuals with Financial Assistance
3. Medicaid expansion to cover household income up to or below 133%
of the federal poverty level (FPL)
ACA Health Insurance Requirements - CORRECT ANSWER
Extension of dependent child to age 26
Expansion of guaranteed Issue - regardless of health status
Prohibits limitations for preventative
Prohibits exclusion for existing condition
Medical Loss Ratio (MLR) ensures at least 80% of premium paid are
spent on healthcare services
Covers EHB (Essential Health Benefits)
Prohibits annual and lifetime limits on EHB
Rating variations can only vary based on age, number of covered
family members, location and tobacco use
Prohibits rating on health status
What is Guaranteed issue? - CORRECT ANSWER Carrier must
offer all plans (not grandfathered) to all individuals
,What is a A health insurance issuer, or issuer - CORRECT ANSWER
an insurance company, insurance service, or insurance organization
(including a health maintenance organization) that is required to be
licensed to engage in the business of insurance in a state and that is
subject to state law that regulates insurance (within the meaning of
Section 514(b)(2) of the Employee Retirement Income Security Act of
1974 [ERISA]). This term does not include a group health plan.
What is a Grandfathered plan - CORRECT ANSWER a group
health plan that was created, or an individual health insurance policy
that was purchased on or before March 23, 2010, has not changed in
certain ways, and for which the issuer disclosed to enrollees that the
plan is grandfathered. Grandfathered plans are exempted from many
requirements of the ACA. Plans or policies may lose their
grandfathered status if they make certain significant changes that
reduce benefits or increase costs to consumers.
Existing Health Condition mandatory coverage went into effect -
CORRECT ANSWER January 1, 2014
What is a existing health condition - CORRECT ANSWER any
health condition or illness that was present before the coverage
effective date, regardless of whether medical advice or treatment was
actually received or recommended.
Under the ACA, health plans that allow coverage of children as
dependents must make dependent coverage available to children up to
age 26.* These young adults can join or remain on a parent's plan even
if they: - CORRECT ANSWER Are married (coverage requirement
does not extend to a married child's spouse)
Are not living with a parent
Are not attending school
Are not financially dependent on a parent
,Are eligible to enroll in their own employer's plan
Have or adopt a child
What is the MLR - (Medical Loss Ratio) - CORRECT ANSWER The
ACA limits the proportion of premiums that a health insurance issuer
can spend on things other than medical claims and improving the
quality of the healthcare of its enrollees. MLR is a basic financial
measurement that generally shows how much of the premium dollars a
health insurance issuer spends on healthcare expenses, as opposed to
profits or administrative costs. A health insurance issuer that does not
spend enough of its premium dollars on healthcare services or quality
improvement activities must provide rebates to individuals and
employers.
Review Question: Last December, you helped Amari enroll in
Marketplace coverage. It's now OE again, and Amari tells you he's
worried he won't be able to sign up for the same plan again because
he had cancer this year and had high utilization of his policy. You tell
Amari he doesn't need to worry, because Marketplace plans don't take
your healthcare spending or health status into consideration when
considering eligibility. What is this policy called?
Guaranteed issue
Guaranteed renewability
Grandfathered plan - CORRECT ANSWER Guaranteed
Renewability
What are the functions of the Marketplace? - CORRECT ANSWER
Certifying health plans to participate in the Marketplace as QHPs*
Determining or assessing individuals' eligibility for enrollment in
Medicaid or CHIP
Carrying out certain plan oversight functions, including monitoring
QHP issuers for continuing compliance with certification requirements
, Determining individuals' eligibility for enrollment in a QHP through the
Marketplace
Determining individuals' eligibility for APTC and CSRs
Facilitating individuals' enrollment in a QHP
Who does HHS rely on to certify QHPs to meet the Marketplace
certification standards in certain areas? - CORRECT ANSWER
States
What is CMS - CORRECT ANSWER Centers for Medicare and
Medicaid Services
It is a federal agency that runs the FFM, Medicare, Medicaid, and CHIP.
For more information, visit CMS.gov. You will learn more about the role
of CMS as it relates to Marketplace-registered agents and brokers in
the Maintaining Compliance module.
What are Agent/Broker Roles in the Marketplace? - CORRECT
ANSWER Agents and brokers can assist individuals with
enrollment in QHPs through the Individual Marketplace, as well as
assist small employers with selecting and enrolling in SHOP coverage.
Agents and brokers may also assist qualified individuals with obtaining
eligibility determinations for financial assistance through the
Marketplace.
If consumers are potentially eligible for Medicaid or CHIP,
Marketplace-registered agents and brokers can help these consumers
connect with the appropriate state agency to apply for this coverage.
Who can assist individuals on the marketplace besides Brokers -
CORRECT ANSWER CAC's
Navigators
EAPS - limited contract
What are Navigators? - CORRECT ANSWER Organizations that
are approved by and receive grants from CMS have certified
Navigators who, among other required duties, must assist consumers
New Agents and Brokers ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+
What is the primary goal of the ACA - CORRECT ANSWER
Provides a premium tax credit (PTC) to help subsidize coverage.
Gives consumers tools to make informed choices about their
healthcare coverage.
Puts in place strong consumer protections
The ACA makes care more accessible by - CORRECT ANSWER 1
- Creating the Health Insurance Marketplace
2 - Provided qualified Individuals with Financial Assistance
3. Medicaid expansion to cover household income up to or below 133%
of the federal poverty level (FPL)
ACA Health Insurance Requirements - CORRECT ANSWER
Extension of dependent child to age 26
Expansion of guaranteed Issue - regardless of health status
Prohibits limitations for preventative
Prohibits exclusion for existing condition
Medical Loss Ratio (MLR) ensures at least 80% of premium paid are
spent on healthcare services
Covers EHB (Essential Health Benefits)
Prohibits annual and lifetime limits on EHB
Rating variations can only vary based on age, number of covered
family members, location and tobacco use
Prohibits rating on health status
What is Guaranteed issue? - CORRECT ANSWER Carrier must
offer all plans (not grandfathered) to all individuals
,What is a A health insurance issuer, or issuer - CORRECT ANSWER
an insurance company, insurance service, or insurance organization
(including a health maintenance organization) that is required to be
licensed to engage in the business of insurance in a state and that is
subject to state law that regulates insurance (within the meaning of
Section 514(b)(2) of the Employee Retirement Income Security Act of
1974 [ERISA]). This term does not include a group health plan.
What is a Grandfathered plan - CORRECT ANSWER a group
health plan that was created, or an individual health insurance policy
that was purchased on or before March 23, 2010, has not changed in
certain ways, and for which the issuer disclosed to enrollees that the
plan is grandfathered. Grandfathered plans are exempted from many
requirements of the ACA. Plans or policies may lose their
grandfathered status if they make certain significant changes that
reduce benefits or increase costs to consumers.
Existing Health Condition mandatory coverage went into effect -
CORRECT ANSWER January 1, 2014
What is a existing health condition - CORRECT ANSWER any
health condition or illness that was present before the coverage
effective date, regardless of whether medical advice or treatment was
actually received or recommended.
Under the ACA, health plans that allow coverage of children as
dependents must make dependent coverage available to children up to
age 26.* These young adults can join or remain on a parent's plan even
if they: - CORRECT ANSWER Are married (coverage requirement
does not extend to a married child's spouse)
Are not living with a parent
Are not attending school
Are not financially dependent on a parent
,Are eligible to enroll in their own employer's plan
Have or adopt a child
What is the MLR - (Medical Loss Ratio) - CORRECT ANSWER The
ACA limits the proportion of premiums that a health insurance issuer
can spend on things other than medical claims and improving the
quality of the healthcare of its enrollees. MLR is a basic financial
measurement that generally shows how much of the premium dollars a
health insurance issuer spends on healthcare expenses, as opposed to
profits or administrative costs. A health insurance issuer that does not
spend enough of its premium dollars on healthcare services or quality
improvement activities must provide rebates to individuals and
employers.
Review Question: Last December, you helped Amari enroll in
Marketplace coverage. It's now OE again, and Amari tells you he's
worried he won't be able to sign up for the same plan again because
he had cancer this year and had high utilization of his policy. You tell
Amari he doesn't need to worry, because Marketplace plans don't take
your healthcare spending or health status into consideration when
considering eligibility. What is this policy called?
Guaranteed issue
Guaranteed renewability
Grandfathered plan - CORRECT ANSWER Guaranteed
Renewability
What are the functions of the Marketplace? - CORRECT ANSWER
Certifying health plans to participate in the Marketplace as QHPs*
Determining or assessing individuals' eligibility for enrollment in
Medicaid or CHIP
Carrying out certain plan oversight functions, including monitoring
QHP issuers for continuing compliance with certification requirements
, Determining individuals' eligibility for enrollment in a QHP through the
Marketplace
Determining individuals' eligibility for APTC and CSRs
Facilitating individuals' enrollment in a QHP
Who does HHS rely on to certify QHPs to meet the Marketplace
certification standards in certain areas? - CORRECT ANSWER
States
What is CMS - CORRECT ANSWER Centers for Medicare and
Medicaid Services
It is a federal agency that runs the FFM, Medicare, Medicaid, and CHIP.
For more information, visit CMS.gov. You will learn more about the role
of CMS as it relates to Marketplace-registered agents and brokers in
the Maintaining Compliance module.
What are Agent/Broker Roles in the Marketplace? - CORRECT
ANSWER Agents and brokers can assist individuals with
enrollment in QHPs through the Individual Marketplace, as well as
assist small employers with selecting and enrolling in SHOP coverage.
Agents and brokers may also assist qualified individuals with obtaining
eligibility determinations for financial assistance through the
Marketplace.
If consumers are potentially eligible for Medicaid or CHIP,
Marketplace-registered agents and brokers can help these consumers
connect with the appropriate state agency to apply for this coverage.
Who can assist individuals on the marketplace besides Brokers -
CORRECT ANSWER CAC's
Navigators
EAPS - limited contract
What are Navigators? - CORRECT ANSWER Organizations that
are approved by and receive grants from CMS have certified
Navigators who, among other required duties, must assist consumers
