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Federal Health Laws

The Affordable Care Act, HIPAA, metal tiers, special enrollment, the employer mandate, and Medicare secondary payer rules.

Study questions and answers

Try each question first, then tap to check your answer.

1. Under the Affordable Care Act, individual and small group major medical plans:

  1. Can exclude preexisting conditions for 12 months
  2. Cannot deny coverage or charge more because of preexisting conditions
  3. Can charge higher premiums based on health status
  4. Can deny coverage to anyone over 64
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B. Cannot deny coverage or charge more because of preexisting conditions
Premiums can vary only by age, tobacco use, family size, and location.

2. Which of the following is NOT one of the ACA's essential health benefits?

  1. Prescription drugs
  2. Mental health services
  3. Maternity and newborn care
  4. Adult dental care
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D. Adult dental care
Pediatric dental and vision care are essential health benefits, but adult dental is not.

3. Under the ACA metal tiers, a bronze plan is designed to cover about what percentage of the average enrollee's costs?

  1. 80%
  2. 60%
  3. 90%
  4. 70%
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B. 60%
Silver covers about 70%, gold about 80%, and platinum about 90%.

4. A person who loses employer coverage generally has how long to enroll in a marketplace plan under a special enrollment period?

  1. 30 days
  2. 6 months
  3. 90 days
  4. 60 days
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D. 60 days
Qualifying life events, such as loss of coverage, marriage, or the birth of a child, open a 60-day window.

5. Under the ACA employer mandate, an applicable large employer is one with at least how many full-time equivalent employees?

  1. 50
  2. 25
  3. 100
  4. 20
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A. 50
Large employers must offer affordable minimum coverage or may face a penalty.

6. HIPAA is best known for:

  1. Creating Medicare Part D
  2. Requiring employers to offer health insurance
  3. Protecting the privacy of health information and improving the portability of group health coverage
  4. Regulating annuity sales
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C. Protecting the privacy of health information and improving the portability of group health coverage
HIPAA's privacy rule protects individually identifiable health information.

7. When an employer with 20 or more employees covers a working employee age 65 or older, which plan is primary?

  1. Medicaid
  2. Medicare
  3. Whichever plan has the lower deductible
  4. The employer's group plan
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D. The employer's group plan
For employers with fewer than 20 employees, Medicare is generally primary.
Next topic: Plan Types and Basics Full health practice test