Aetna Individual Core Certification
AETNA INDIVIDUAL CORE CERTIFICATION | LATEST EXAM
QUESTIONS AND SOLUTIONS - VERIFIED ANSWERS
2026/2027
1. Under the Affordable Care Act, which type of coverage is sold to
people who buy health insurance on their own rather than through an
employer?
A. Medicare Supplement coverage
B. Individual and family coverage
C. Self-funded ERISA coverage
D. Large group coverage
B. Individual and family coverage
Individual market plans are purchased directly by a person or family, on
or off the Marketplace, rather than through an employer group.
2. Which federal law created the Health Insurance Marketplaces?
A. The Health Insurance Portability and Accountability Act
B. The Patient Protection and Affordable Care Act
C. The Employee Retirement Income Security Act
D. The Consolidated Omnibus Budget Reconciliation Act
B. The Patient Protection and Affordable Care Act
The ACA, signed in 2010, established the Marketplaces (Exchanges) where
individuals can compare and buy qualified health plans.
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, Aetna Individual Core Certification
3. A plan that is certified to be sold on a Health Insurance Marketplace
is called a:
A. Health care sharing ministry plan
B. Short-term limited duration plan
C. Qualified Health Plan (QHP)
D. Fixed indemnity plan
C. Qualified Health Plan (QHP)
Only Qualified Health Plans meeting federal and state certification
standards can be offered on the Marketplace.
4. What are the four standard metal levels of Marketplace coverage?
A. Bronze, Silver, Gold, Platinum
B. Copper, Bronze, Silver, Gold
C. Basic, Standard, Premium, Elite
D. Bronze, Silver, Gold, Diamond
A. Bronze, Silver, Gold, Platinum
Metal levels group plans by actuarial value; catastrophic plans are a
separate category, not a metal tier.
5. Approximately what actuarial value does a Silver plan carry?
A. 60%
B. 70%
C. 80%
D. 90%
B. 70%
Silver plans are designed to pay about 70% of average covered costs, with
the member paying about 30%.
6. Approximately what actuarial value does a Bronze plan carry?
A. 60%
B. 50%
C. 80%
D. 70%
A. 60%
Bronze plans pay about 60% of average covered costs, giving lower
premiums but higher out-of-pocket costs.
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, Aetna Individual Core Certification
7. Approximately what actuarial value does a Gold plan carry?
A. 60%
B. 90%
C. 70%
D. 80%
D. 80%
Gold plans pay roughly 80% of average costs, so premiums are higher and
cost-sharing is lower.
8. Cost-Sharing Reductions (CSRs) are available only when the eligible
enrollee chooses which metal level?
A. Bronze
B. Gold
C. Platinum
D. Silver
D. Silver
CSRs lower deductibles, copays and coinsurance, but the enrollee must
pick a Silver plan to receive them (except special rules for American
Indians/Alaska Natives).
9. Which enrollees are generally eligible for a catastrophic plan?
A. Anyone receiving premium tax credits
B. Only people over age 50
C. Only Medicare beneficiaries
D. People under age 30 or those with a hardship or affordability
exemption
D. People under age 30 or those with a hardship or affordability
exemption
Catastrophic plans are limited to those under 30 or those who qualify for
a hardship or affordability exemption.
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, Aetna Individual Core Certification
10. Can premium tax credits be applied to a catastrophic plan?
A. Only if the enrollee is under 26
B. Only during Open Enrollment
C. No
D. Yes, always
C. No
Advance premium tax credits cannot be used to lower premiums on
catastrophic plans.
11. What does APTC stand for?
A. Annual Premium Tax Coverage
B. Applied Plan Tax Credit
C. Approved Premium Treatment Cost
D. Advance Premium Tax Credit
D. Advance Premium Tax Credit
APTC is the portion of the premium tax credit paid directly to the insurer
each month to lower the enrollee's premium.
12. Premium tax credits are calculated using which benchmark plan?
A. The lowest-cost Bronze plan in the area
B. The average Platinum plan in the state
C. The second-lowest-cost Silver plan in the area
D. The highest-cost Gold plan in the area
C. The second-lowest-cost Silver plan in the area
The benchmark is the second-lowest-cost Silver plan (SLCSP) available to
the household.
13. At tax time, a consumer who received APTC must reconcile it using
which IRS form?
A. Form W-4
B. Form 8962
C. Form 1099-MISC
D. Form 1040-ES
B. Form 8962
Form 8962 compares APTC received with the actual credit based on final
household income.
Page 4 of 56
AETNA INDIVIDUAL CORE CERTIFICATION | LATEST EXAM
QUESTIONS AND SOLUTIONS - VERIFIED ANSWERS
2026/2027
1. Under the Affordable Care Act, which type of coverage is sold to
people who buy health insurance on their own rather than through an
employer?
A. Medicare Supplement coverage
B. Individual and family coverage
C. Self-funded ERISA coverage
D. Large group coverage
B. Individual and family coverage
Individual market plans are purchased directly by a person or family, on
or off the Marketplace, rather than through an employer group.
2. Which federal law created the Health Insurance Marketplaces?
A. The Health Insurance Portability and Accountability Act
B. The Patient Protection and Affordable Care Act
C. The Employee Retirement Income Security Act
D. The Consolidated Omnibus Budget Reconciliation Act
B. The Patient Protection and Affordable Care Act
The ACA, signed in 2010, established the Marketplaces (Exchanges) where
individuals can compare and buy qualified health plans.
Page 1 of 56
, Aetna Individual Core Certification
3. A plan that is certified to be sold on a Health Insurance Marketplace
is called a:
A. Health care sharing ministry plan
B. Short-term limited duration plan
C. Qualified Health Plan (QHP)
D. Fixed indemnity plan
C. Qualified Health Plan (QHP)
Only Qualified Health Plans meeting federal and state certification
standards can be offered on the Marketplace.
4. What are the four standard metal levels of Marketplace coverage?
A. Bronze, Silver, Gold, Platinum
B. Copper, Bronze, Silver, Gold
C. Basic, Standard, Premium, Elite
D. Bronze, Silver, Gold, Diamond
A. Bronze, Silver, Gold, Platinum
Metal levels group plans by actuarial value; catastrophic plans are a
separate category, not a metal tier.
5. Approximately what actuarial value does a Silver plan carry?
A. 60%
B. 70%
C. 80%
D. 90%
B. 70%
Silver plans are designed to pay about 70% of average covered costs, with
the member paying about 30%.
6. Approximately what actuarial value does a Bronze plan carry?
A. 60%
B. 50%
C. 80%
D. 70%
A. 60%
Bronze plans pay about 60% of average covered costs, giving lower
premiums but higher out-of-pocket costs.
Page 2 of 56
, Aetna Individual Core Certification
7. Approximately what actuarial value does a Gold plan carry?
A. 60%
B. 90%
C. 70%
D. 80%
D. 80%
Gold plans pay roughly 80% of average costs, so premiums are higher and
cost-sharing is lower.
8. Cost-Sharing Reductions (CSRs) are available only when the eligible
enrollee chooses which metal level?
A. Bronze
B. Gold
C. Platinum
D. Silver
D. Silver
CSRs lower deductibles, copays and coinsurance, but the enrollee must
pick a Silver plan to receive them (except special rules for American
Indians/Alaska Natives).
9. Which enrollees are generally eligible for a catastrophic plan?
A. Anyone receiving premium tax credits
B. Only people over age 50
C. Only Medicare beneficiaries
D. People under age 30 or those with a hardship or affordability
exemption
D. People under age 30 or those with a hardship or affordability
exemption
Catastrophic plans are limited to those under 30 or those who qualify for
a hardship or affordability exemption.
Page 3 of 56
, Aetna Individual Core Certification
10. Can premium tax credits be applied to a catastrophic plan?
A. Only if the enrollee is under 26
B. Only during Open Enrollment
C. No
D. Yes, always
C. No
Advance premium tax credits cannot be used to lower premiums on
catastrophic plans.
11. What does APTC stand for?
A. Annual Premium Tax Coverage
B. Applied Plan Tax Credit
C. Approved Premium Treatment Cost
D. Advance Premium Tax Credit
D. Advance Premium Tax Credit
APTC is the portion of the premium tax credit paid directly to the insurer
each month to lower the enrollee's premium.
12. Premium tax credits are calculated using which benchmark plan?
A. The lowest-cost Bronze plan in the area
B. The average Platinum plan in the state
C. The second-lowest-cost Silver plan in the area
D. The highest-cost Gold plan in the area
C. The second-lowest-cost Silver plan in the area
The benchmark is the second-lowest-cost Silver plan (SLCSP) available to
the household.
13. At tax time, a consumer who received APTC must reconcile it using
which IRS form?
A. Form W-4
B. Form 8962
C. Form 1099-MISC
D. Form 1040-ES
B. Form 8962
Form 8962 compares APTC received with the actual credit based on final
household income.
Page 4 of 56
