PY 2024 Individual Marketplace Training
for New Agents and Brokers Exam
Questions and Answers
What is the primary goal of the ACA - Correct Answers
✅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 Answers
✅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 Answers
✅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
,PY 2024 Individual Marketplace Training
for New Agents and Brokers Exam
Questions and Answers
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 Answers ✅Carrier
must offer all plans (not grandfathered) to all individuals
What is a A health insurance issuer, or issuer - Correct
Answers ✅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 Answers ✅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.
, PY 2024 Individual Marketplace Training
for New Agents and Brokers Exam
Questions and Answers
Existing Health Condition mandatory coverage went into
effect - Correct Answers ✅January 1, 2014
What is a existing health condition - Correct Answers ✅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 Answers ✅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
for New Agents and Brokers Exam
Questions and Answers
What is the primary goal of the ACA - Correct Answers
✅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 Answers
✅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 Answers
✅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
,PY 2024 Individual Marketplace Training
for New Agents and Brokers Exam
Questions and Answers
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 Answers ✅Carrier
must offer all plans (not grandfathered) to all individuals
What is a A health insurance issuer, or issuer - Correct
Answers ✅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 Answers ✅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.
, PY 2024 Individual Marketplace Training
for New Agents and Brokers Exam
Questions and Answers
Existing Health Condition mandatory coverage went into
effect - Correct Answers ✅January 1, 2014
What is a existing health condition - Correct Answers ✅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 Answers ✅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
