Unit 13 - Affordable Care Act

Question 1

What are the Metal Tiers?

Answer 1

Bronze plan
Silver plan
Gold plan
Platinum plan

Question 2

What is the average portion of expected costs each Metal Tiers plan will cover?

Answer 2

Bronze plan - 60%
Silver plan - 70%
Gold plan - 80%
Platinum plan - 90%

Question 3

What are the events that can occur to be able to apply outside of open enrollment?

Answer 3

• Marriage
• Birth or adoption of a child
• Permanently moving to an area that offers different health plans
• Loss of health coverage due to divorce, job loss, or loss of eligibility for coverage

Question 4

What is a Qualified Health Plan (QHP)?

Answer 4

Insurance plans sold on the health insurance exchange..

• Provide EHBs (Essential Health Benefits)
• Only available on the exchange
• Only plan that provides tax credits and cost sharing

Question 5

What is Small Business Health Options Program (SHOP)?

Answer 5

The SHOP market place provides an online application where small employers can shop and compare a variety of health insurance plans. The employer must have 50 or fewer full-time employees.

Question 6

What are subsidies?

Answer 6

• A sum of money given by the federal government
• Could be given in Advanced Premium Tax Credits (APTC)
• Cost-sharing - Lower co-payment, coinsurance and out of pocket limits (only available on Silver Tier)

Question 7

What are Navigators?

Answer 7

Navigators are funded by the federal government to help individuals determine their eligibility for public assistance programs using the health insurance exchange / marketplace website.
They cannot give advice or sell insurance.

Question 8

What is the Employer Mandate / Employer Shared Responsibility?

Answer 8

Employers with 50+ employees or full time equivalents must pay $2,000 per full time employee if the employer doesn’t offer healthcare coverage AND at least one full time employee receives a subsidy for coverage purchased through the health insurance exchange.

If the employer does offer coverage but have at least one full time employee receiving a subsidy the employer will pay the lesser of $3,000 for each employee receiving subsidy OR $2,000 for each full time employee (excluding the first 30 employees)

• Does not apply to employers with 50 or fewer employees.

Question 9

What is the Health Care Tax Credit for Small Employers?

Answer 9

Health care tax credit

• Maximum credit
  
  • – 50% of premiums paid for small business employers
  • – 35% of premiums paid for small tax-exempt employers
  • – Eligible for 2 years