ACA Introduction Set Exam Questions
and Answers with Verified Solutions |
Latest Updated 2026
The Affordable Care Act (ACA) A federal law signed March 23, 2010
that expanded health insurance
coverage, improved affordability,
and added consumer protections.
ACA Gap Mitigation (Issues High uninsured rates, unaffordable
addressed) coverage, pre-existing condition
exclusions, and coverage limits.
ACA Marketplaces (Exchanges) Organized markets where
individuals and families can
compare plans and receive financial
assistance.
On-exchange versus They can be medically identical; the
off-exchange plans difference is where they are sold
and whether subsidies apply.
Marketplace Eligibility and People without access to affordable
Coverage employer coverage, Medicare,
Medicaid, or CHIP.
Essential Health Benefits Ten mandatory benefit categories
(EHBs) required in ACA individual and
small-group plans. 1) Outpatient
care 2) emergency 3) hospitalization
4) maternity/newborn 5) mental
, health/SUD 6) prescription drugs 7)
rehab/habilitative 8) labs 9)
preventive/chronic 10) pediatric
dental/vision
EHBs constraints and benefit Plans must cover all categories and
design be substantially equal to the state
benchmark.
The state EHB benchmark plan A reference plan that defines the
scope of EHBs in a state.
How do plans manage EHBs By shaping cost-sharing, limits, and
definitions-not by excluding
coverage.
Actuarial value (AV) The average percentage of EHB
costs paid by the plan for a standard
population.
ACA metal tiers Bronze 60% Silver 70% Gold 80%
Platinum 90%
Purpose of metal tiers To standardize plan generosity and
allow easier consumer comparison.
AV compliance All cost-sharing combined must fall
within the metal tier's allowed AV
range.
Cost-sharing The portion of health care costs
members pay when using care.
and Answers with Verified Solutions |
Latest Updated 2026
The Affordable Care Act (ACA) A federal law signed March 23, 2010
that expanded health insurance
coverage, improved affordability,
and added consumer protections.
ACA Gap Mitigation (Issues High uninsured rates, unaffordable
addressed) coverage, pre-existing condition
exclusions, and coverage limits.
ACA Marketplaces (Exchanges) Organized markets where
individuals and families can
compare plans and receive financial
assistance.
On-exchange versus They can be medically identical; the
off-exchange plans difference is where they are sold
and whether subsidies apply.
Marketplace Eligibility and People without access to affordable
Coverage employer coverage, Medicare,
Medicaid, or CHIP.
Essential Health Benefits Ten mandatory benefit categories
(EHBs) required in ACA individual and
small-group plans. 1) Outpatient
care 2) emergency 3) hospitalization
4) maternity/newborn 5) mental
, health/SUD 6) prescription drugs 7)
rehab/habilitative 8) labs 9)
preventive/chronic 10) pediatric
dental/vision
EHBs constraints and benefit Plans must cover all categories and
design be substantially equal to the state
benchmark.
The state EHB benchmark plan A reference plan that defines the
scope of EHBs in a state.
How do plans manage EHBs By shaping cost-sharing, limits, and
definitions-not by excluding
coverage.
Actuarial value (AV) The average percentage of EHB
costs paid by the plan for a standard
population.
ACA metal tiers Bronze 60% Silver 70% Gold 80%
Platinum 90%
Purpose of metal tiers To standardize plan generosity and
allow easier consumer comparison.
AV compliance All cost-sharing combined must fall
within the metal tier's allowed AV
range.
Cost-sharing The portion of health care costs
members pay when using care.
