PUBH 6012 Exam #2 Questions and Answers |Complete Solutions Graded A+ |100% Correct
High Deductible Health Plan (Managed Care) features high deductibles, comes with tax
benefits
Catastrophic Plan (Managed Care) Extremely high deductible that only comes in if
something really terrible happens
Short Term Health Insurance (Managed Care) A stopgap plan with limited benefits (excludes
pre-existing conditions, might not cover rx), not minimum essential coverage for purposes of
ACA
What year did the ACA pass? 2010
ACA New Rules for Insurers - Cant deny coverage for preexisting conditions
- only alowed to vary premiums based on age, geographic region, tobacco use, # of family
members
- No lifetime limits and cant rescind coverage
- Young adults can stay on parents plan until 26
- Waiting period for coverage limited to 90 days
Subsidies -For individuals between 133% and 400% of federal poverty limit (FPL)
- Only if employer doesn't offer OR if employee's share for coverage exceeds 9.5% of income
- Additional subsidies to cover cost sharing under 250% of FPL'
- For small businesses under 50 employees
Medical Loss Ratio Insurers to spend a certain % of their premium income on medical care
and health care quality improvement, leaving the rest for admin, marketing, and profit
(individual and small group markets: 80%; large group markets: 85%))
, higher MLR indicates a larger proportion of premiums is being spent on health insurance plans,
lower MLR means that more is being spent on admin, marketing, and profit)
Minimum value quality of large employer plans -pays at least 60% of the total cost of
medical services for standard population
-benefits include substantial coverage of physical and inpatient hospital services
affordability of large employer plans -Job based health plan that costs 9.5% of employees
income
-If its unaffordable, you can get a tax credit in the ACA marketplace and employer has to pay a
penalty
ACA benefits Free std screenings, vaccinations, mental health screenings, PrEP
State Health Insurance Exchanges State can opt out, federal govt must create one for state
residents
Cost Sharing Based on Value Bronze: ins pays 60%/individual pays 40%
Silver: 70/30
Gold: 80/20
Platinum: 90/10
Premium Tax Credits Marketplace enrollees are eligible for premium subsidy if income
between 100-400% FPL
Reduces the premium in which individuals are charged
Coverage Gap Congress drafted the law to cover everyone up to 133% FPL on medicaid, and
then subsidies to go from 100 to 400% FPL
Supreme court ruled that medicaid expansion had to be optional for states
High Deductible Health Plan (Managed Care) features high deductibles, comes with tax
benefits
Catastrophic Plan (Managed Care) Extremely high deductible that only comes in if
something really terrible happens
Short Term Health Insurance (Managed Care) A stopgap plan with limited benefits (excludes
pre-existing conditions, might not cover rx), not minimum essential coverage for purposes of
ACA
What year did the ACA pass? 2010
ACA New Rules for Insurers - Cant deny coverage for preexisting conditions
- only alowed to vary premiums based on age, geographic region, tobacco use, # of family
members
- No lifetime limits and cant rescind coverage
- Young adults can stay on parents plan until 26
- Waiting period for coverage limited to 90 days
Subsidies -For individuals between 133% and 400% of federal poverty limit (FPL)
- Only if employer doesn't offer OR if employee's share for coverage exceeds 9.5% of income
- Additional subsidies to cover cost sharing under 250% of FPL'
- For small businesses under 50 employees
Medical Loss Ratio Insurers to spend a certain % of their premium income on medical care
and health care quality improvement, leaving the rest for admin, marketing, and profit
(individual and small group markets: 80%; large group markets: 85%))
, higher MLR indicates a larger proportion of premiums is being spent on health insurance plans,
lower MLR means that more is being spent on admin, marketing, and profit)
Minimum value quality of large employer plans -pays at least 60% of the total cost of
medical services for standard population
-benefits include substantial coverage of physical and inpatient hospital services
affordability of large employer plans -Job based health plan that costs 9.5% of employees
income
-If its unaffordable, you can get a tax credit in the ACA marketplace and employer has to pay a
penalty
ACA benefits Free std screenings, vaccinations, mental health screenings, PrEP
State Health Insurance Exchanges State can opt out, federal govt must create one for state
residents
Cost Sharing Based on Value Bronze: ins pays 60%/individual pays 40%
Silver: 70/30
Gold: 80/20
Platinum: 90/10
Premium Tax Credits Marketplace enrollees are eligible for premium subsidy if income
between 100-400% FPL
Reduces the premium in which individuals are charged
Coverage Gap Congress drafted the law to cover everyone up to 133% FPL on medicaid, and
then subsidies to go from 100 to 400% FPL
Supreme court ruled that medicaid expansion had to be optional for states
