Indiana Navigator Exam Questions & Answers Solved Completely

Define Maryland Health Connection - Answer The new marketplace in the state to compare health insurance options and enroll in health coverage. Name the important elements of the Maryland Health Connection - Answer 1. New Marketplace to shop and compare health insurance. 2. No Wrong Door 3. Only place to qualify for Advance Premium Tax Credits and Cost Sharing Reductions 4. Private and Government plans What are the four ways consumers can apply for health care coverage? - Answer 1. Online at 2. In person 3. On the phone 4. By mail What are the 6 types of consumer assistance workers - Answer Navigators Assisters Caseworkers Consolidated Services Center Representatives Producers Application Counselors True or False If Sally enrolls in Qualified Health Plan and her payment is posted by the 18th of February, Sally can submit her health bills for services she received for the entire month of February. - Answer False There are no retroactive enrollment dates for private health insurance What is the date that a payment must be POSTED for coverage to be effective on the 1st day of the following month? - Answer 18th When will individuals eligible for Medicaid have coverage effective? - Answer On the first day of the month in which they enroll What does the acronym FPL stand for? - Answer Federal Poverty Level Define "Affordable" health insurance - Answer Health Insurance with premium costs less than a certain percentage of an individual's income. The percentage is based on the Federal Poverty Level Up to 133% FPL = 2.00% 134 - 150% = 4.00% 151 - 200% = 6.30% 201 - 250% = 8.05% 251 - 400% = 9.5% Some people may be exempt from having health insurance. Name the 6 exemptions. - Answer 1. Financial hardship 2. Religious objections 3. Members of a federally recognized Indian tribe 4. Those without coverage for less than three months 5. Incarcerated individuals 6. Consumers with incomes below the tax filing threshold Consumers without health insurance coverage will be required to pay a tax penalty. Tax penalties will be phased in how? - Answer 2014 - $95 per adult or 1% of income (whichever is higher) 2015 - $325 or 2% of income (whichever is higher) 2016 - $695 or 2.5% of income (whichever is higher) What does the acronym SBC stand for - Answer Summary of Benefits and Coverage Insurance companies and group health plans must provide consumers with two things. What are they? - Answer Summary of Benefits and Coverage Uniform Glossary of Terms True or False Lifetime and yearly dollar limits on coverage of essential health benefits are no longer permitted. - Answer True What does the acronym MAGI stand for? - Answer Modified Adjusted Gross Income What does the acronym QHP stand for? - Answer Qualified Health Plan Define Qualified Health Plan (QHP) - Answer A private health benefit plan that has been certified by Maryland Health Connection to meet requirements for certification under the ACA and Maryland law. Qualified Health Plans offered on the Maryland Health Connection must meet requirements for what four areas? - Answer Metal Level and Actuarial Values Essential Health Benefits Network Design Cost Sharing Limits True of False No financial assistance is available directly for Qualified Dental Plans (QDP) - Answer True However, an individual who is eligible for financial assistance with a QHP could select a lower-cost plan and use the savings to pay for a QDP Name the four metal levels of health insurance plans on the marketplace - Answer Bronze Silver Gold Platinum Name the 10 core benefits that each insurance plan on the marketplace must cover - Answer 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and rehabilitative services and devices 8. Laboratory services 9. Preventative and wellness services and chronic disease management 10. Pediatric services, including oral and vision care True or False Qualified Health Plans must maintain a network that is sufficient in number and types of providers. - Answer True True or False Insurance companies will be allowed to set limits on the dollar amount of essential health benefits they will cover in a single year or over the course of a person's lifetime. - Answer False Insurance companies will NO LONGER be allowed to set limits on the dollar amount of essential health benefits they will cover in a single year or over the course of a person's lifetime. Name the two financial assistance programs associated with Qualified Health Plans - Answer 1. Advanced Premium Tax Credits (APTC) 2. Cost Sharing Reductions (CSR) What does the acronym APTC stand for? - Answer Advanced Premium Tax Credits What does the acronym CSR stand for? - Answer Cost Sharing Reductions Advanced Premium Tax Credits helps consumers with what? - Answer Premium costs Cost Sharing Reductions helps consumers with what? - Answer Out-of-pocket expenses such as co-payments, deductibles, and coinsurance Who will be eligible for Advanced Premium Tax Credits? - Answer Individuals and families with incomes between 138% and 400% Federal Poverty Level who enroll in a Qualified Health Plan ($45,960 for an individual and $94, 200 for a family of four) AND Lack access to minimum essential coverage Who will be eligible for Cost Sharing Reductions? - Answer Individuals and families with incomes between 138% and 250% Federal Poverty Level who enroll in a Silver Level Qualified Health Plan Define Minimum Essential Coverage - Answer Coverage that meets minimum value and affordability requirements. Minimum Value: It pays for 60% of the benefits covered by the plan; individuals pay no more than 40% Affordability: Individuals are required to contribute 9.5% of their income or less toward the plan. True or False Individuals currently enrolled in employer-sponsored coverage (regardless of whether it is affordable or meets minimum value standard) will not be determined eligible for Advanced Premium Tax Credits. - Answer True The dollar amount of the credit an individual is eligible to receive depends on what two factors? - Answer 1. The individual's household income 2. The cost of the second-lowest-cost Silver plan available Individuals eligible for an Advanced Premium Tax Credit (APTC) can choose one of three ways to apply the tax credit. Name the three ways. - Answer 1. The entire amount up front. 2. A portion up front. 3. None, until they file their federal tax return. True or False If an individual chooses to take the full amount of the Advanced Premium Tax Credit (APTC) that they qualify for they will be responsible for passing the APTC amount on to their insurance carrier. - Answer False The Advanced Premium Tax Credit amount is passed directly from the US Treasury to the insurance carrier. True or False The amount of the Advanced Premium Tax Credits that a person qualifies for during the application process never changes. - Answer False Their qualifying status changes during the year. (For example, if they receive a salary increase that disqualifies them for that credit, they will need to reconcile the difference on their federal tax return)