MCQ Quiz-Exchanges

MCQ Quiz: Exchanges

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The Health Insurance Exchanges, or Marketplaces, created by the Patient Protection and Affordable Care Act (ACA), represent a significant component of the U.S. health insurance system. They provide a platform for individuals and families to compare and purchase private health plans. For PharmD students, understanding the structure of these plans, including their formularies, cost-sharing, and subsidies, is essential for effectively assisting patients who rely on the Exchanges for their coverage.

1. The Health Insurance Exchanges, also known as Marketplaces, were established as a result of which major piece of legislation?

  • The Social Security Act of 1965
  • The Health Insurance Portability and Accountability Act (HIPAA)
  • The Patient Protection and Affordable Care Act (ACA)
  • The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90)


Answer: The Patient Protection and Affordable Care Act (ACA)

2. What is the primary purpose of a Health Insurance Exchange?

  • To provide a single, government-run health insurance plan
  • To create a centralized market for individuals and small businesses to compare and purchase private health insurance
  • To regulate the price of all prescription drugs
  • To manage the Medicare Part D program


Answer: To create a centralized market for individuals and small businesses to compare and purchase private health insurance

3. Plans on the Health Insurance Exchange are categorized into “metal tiers” (Bronze, Silver, Gold, Platinum). What do these tiers primarily represent?

  • The number of doctors in the network
  • The quality of care provided by the plan
  • The actuarial value, or how the plan and member share costs
  • The geographic region the plan serves


Answer: The actuarial value, or how the plan and member share costs

4. A plan with a lower monthly premium but higher out-of-pocket costs when care is needed would most likely be which metal tier?

  • Platinum
  • Gold
  • Silver
  • Bronze


Answer: Bronze

5. To be sold on the Exchange, a qualified health plan must cover a set of ten service categories known as:

  • The National Formulary
  • The Minimum Coverage List
  • Essential Health Benefits (EHBs)
  • The Preferred Drug List


Answer: Essential Health Benefits (EHBs)

6. Which of the following is included as one of the ten Essential Health Benefits?

  • Cosmetic surgery
  • Prescription drugs
  • Experimental treatments
  • Long-term custodial care


Answer: Prescription drugs

7. Premium Tax Credits are subsidies available to eligible individuals on the Exchange to help lower their:

  • Monthly insurance premium costs
  • Deductible
  • Coinsurance percentage
  • Out-of-pocket maximum


Answer: Monthly insurance premium costs

8. Eligibility for Premium Tax Credits on the Health Insurance Exchange is primarily based on:

  • Age and gender
  • Household income relative to the Federal Poverty Level (FPL)
  • Pre-existing medical conditions
  • The state in which the individual resides


Answer: Household income relative to the Federal Poverty Level (FPL)

9. Cost-Sharing Reductions (CSRs) are an additional subsidy that helps lower deductibles and copayments for eligible individuals who enroll in which specific metal tier?

  • Bronze
  • Silver
  • Gold
  • Platinum


Answer: Silver

10. The specific time frame each year when anyone can enroll in a Health Insurance Exchange plan is known as the:

  • Special Enrollment Period
  • Initial Enrollment Period
  • Open Enrollment Period
  • Benefits Verification Period


Answer: Open Enrollment Period

11. A person who loses their employer-sponsored health coverage would likely qualify for a(n):

  • Premium increase
  • Special Enrollment Period (SEP) to enroll in an Exchange plan
  • Lifetime ban from the Marketplace
  • Mandatory waiting period of one year


Answer: Special Enrollment Period (SEP) to enroll in an Exchange plan

12. Health Insurance Exchanges can be operated by:

  • The individual states
  • The federal government
  • A partnership between the state and federal government
  • All of the above


Answer: All of the above

13. A key role for a pharmacist is to help patients:

  • Choose and enroll in an Exchange plan that best covers their medications
  • File their income taxes to qualify for subsidies
  • Negotiate their monthly premium with the insurance company
  • Perform their own medical diagnoses


Answer: Choose and enroll in an Exchange plan that best covers their medications

14. The prescription drug benefit for plans sold on the Exchange is typically managed by a:

  • Hospital system
  • Pharmacy Benefit Manager (PBM)
  • Pharmaceutical manufacturer
  • Physician’s office


Answer: A Pharmacy Benefit Manager (PBM)

15. A patient with an Exchange plan may still face a high out-of-pocket cost for a medication due to:

  • The plan’s deductible
  • The drug being on a high formulary tier
  • A coinsurance requirement
  • All of the above


Answer: All of the above

16. The ACA prevents insurance plans on the Exchange from denying coverage based on:

  • Geographic location
  • Age
  • Pre-existing conditions
  • Income level


Answer: Pre-existing conditions

17. A Platinum plan sold on the Marketplace would be expected to have:

  • The lowest monthly premium and highest deductible
  • The highest monthly premium and lowest cost-sharing when care is needed
  • No prescription drug coverage
  • A very limited network of providers


Answer: The highest monthly premium and lowest cost-sharing when care is needed

18. What is the primary target audience for the Health Insurance Exchanges?

  • Individuals and families who do not have access to affordable employer-sponsored insurance
  • People eligible for Medicare
  • People eligible for Medicaid
  • Large corporations with thousands of employees


Answer: Individuals and families who do not have access to affordable employer-sponsored insurance

19. When assisting a patient with plan selection on the Exchange, it is most important for a pharmacist to review the plan’s:

  • Marketing slogan
  • Formulary to check coverage of the patient’s current medications
  • List of corporate officers
  • Stock market performance


Answer: Formulary to check coverage of the patient’s current medications

20. A plan’s “actuarial value” refers to the:

  • Total number of members enrolled in the plan
  • Percentage of total average costs for covered benefits that a plan will cover
  • Number of years the plan has been in business
  • The plan’s 5-Star Quality Rating


Answer: The percentage of total average costs for covered benefits that a plan will cover

21. A patient with a Gold plan on the Exchange would generally have ________ monthly premiums and ________ out-of-pocket costs than a patient with a Bronze plan.

  • lower; lower
  • higher; lower
  • lower; higher
  • higher; higher


Answer: higher; lower

22. A pharmacist may need to help a patient with an Exchange plan navigate what common utilization management requirement?

  • A medication reconciliation
  • A prior authorization for a high-cost medication
  • A therapeutic drug monitoring test
  • A non-sterile compounded prescription


Answer: A prior authorization for a high-cost medication

23. The creation of the Health Insurance Exchanges was part of a broader legislative effort to:

  • Decrease the number of insured Americans
  • Increase the number of insured Americans
  • Eliminate private health insurance
  • Make Medicare available to everyone


Answer: Increase the number of insured Americans

24. A patient’s eligibility for Cost-Sharing Reductions (CSRs) is lost if they choose what type of plan?

  • A Silver plan
  • A Bronze or Gold plan
  • Any plan offered on the Exchange
  • An employer-sponsored plan


Answer: A Bronze or Gold plan

25. Like other forms of managed care, Exchange plans utilize ________ to manage drug costs and use.

  • formularies, pharmacy networks, and utilization management tools
  • only copayments
  • only deductibles
  • direct negotiation with patients


Answer: formularies, pharmacy networks, and utilization management tools

26. The “family glitch” was a prior issue related to the ACA where family members were often ineligible for Exchange subsidies if:

  • One family member had access to “affordable” self-only coverage from an employer
  • The family’s income was too low
  • The family lived in a rural area
  • The family had no children


Answer: One family member had access to “affordable” self-only coverage from an employer

27. A key function of the Exchange website (e.g., HealthCare.gov) is to:

  • Provide medical advice and diagnoses
  • Standardize the presentation of plan information to allow for easier comparison
  • Allow users to purchase international health plans
  • List the prices of all surgical procedures


Answer: Standardize the presentation of plan information to allow for easier comparison

28. An individual who does not have health insurance and does not qualify for an exemption may face a:

  • prison sentence
  • tax penalty, depending on current law
  • lifetime ban from receiving healthcare
  • mandatory enrollment in Medicare


Answer: tax penalty, depending on current law

29. The prescription drug benefit is one of the ten ________ that all Exchange plans must cover.

  • Prior Authorization Requirements
  • Essential Health Benefits
  • State-Mandated Services
  • Pharmacy Network Types


Answer: Essential Health Benefits

30. A person’s Premium Tax Credit amount is reconciled when they:

  • File their federal income taxes
  • Visit the emergency room
  • Renew their driver’s license
  • Turn 65 years old


Answer: File their federal income taxes

31. Which metal tier plan has the highest actuarial value?

  • Bronze
  • Silver
  • Gold
  • Platinum


Answer: Platinum

32. For a PharmD student, understanding the Exchanges is important as they represent a major segment of what type of insurance?

  • Government-run insurance
  • Commercial insurance for individuals
  • Disability insurance
  • Workers’ compensation


Answer: Commercial insurance for individuals

33. What happens if a patient with an Exchange plan goes to a pharmacy that is not in their plan’s network?

  • The prescription will be free of charge
  • The prescription will likely not be covered, or will have a much higher cost-share
  • The pharmacist is required to join the network on the spot
  • The PBM will pay the pharmacy double the normal rate


Answer: The prescription will likely not be covered, or will have a much higher cost-share

34. The “Affordable” in the ACA refers to provisions like subsidies that are designed to:

  • Make premiums and cost-sharing manageable for low- and moderate-income individuals
  • Ensure all healthcare services are free
  • Increase the overall cost of health insurance
  • Provide housing assistance


Answer: Make premiums and cost-sharing manageable for low- and moderate-income individuals

35. A catastrophic health plan on the Exchange is typically available only to:

  • People over age 65
  • People with very high incomes
  • People under 30 or those with a hardship exemption
  • People with no pre-existing conditions


Answer: People under 30 or those with a hardship exemption

36. A significant challenge for patients on the Exchange can be:

  • The simplicity of choosing a plan
  • Navigating complex plan details and affording deductibles and cost-sharing
  • Having too many doctors in the network
  • The lack of any prescription drug coverage


Answer: Navigating complex plan details and affording deductibles and cost-sharing

37. If a patient’s income changes mid-year, what should they do regarding their Exchange plan?

  • Nothing, as it has no effect on their subsidy
  • Cancel their plan immediately
  • Report the change to the Marketplace to adjust their premium tax credit
  • Wait until the end of the year to report the change


Answer: Report the change to the Marketplace to adjust their premium tax credit

38. The formulary for an Exchange plan must have a process for patients to request:

  • A non-formulary drug if medically necessary
  • A refund for their monthly premium
  • A list of all other patients taking the same drug
  • A different doctor


Answer: A non-formulary drug if medically necessary

39. Health Insurance Navigators are individuals or organizations trained to help consumers:

  • Choose the most expensive plan available
  • Understand their options and enroll in coverage on the Exchange
  • Diagnose their medical conditions
  • File a medical malpractice lawsuit


Answer: Understand their options and enroll in coverage on the Exchange

40. A Bronze plan typically covers what percentage of healthcare costs for an average population?

  • 90%
  • 80%
  • 70%
  • 60%


Answer: 60%

41. The establishment of the Exchanges addressed the problem of the pre-ACA ________ market, where coverage could be denied or be very expensive.

  • group insurance
  • individual insurance
  • Medicare
  • Medicaid


Answer: individual insurance

42. Which statement about Exchange plans is true?

  • All plans from all insurers have the exact same formulary and provider network
  • Plans can differ significantly in their formularies, networks, premiums, and deductibles
  • Patients do not have to pay a monthly premium
  • Enrollment is open at any time of the year for any reason


Answer: Plans can differ significantly in their formularies, networks, premiums, and deductibles

43. A pharmacist’s role can include helping a patient find a more affordable medication that is on their Exchange plan’s ________ tier.

  • highest
  • non-preferred
  • specialty
  • lowest or preferred


Answer: lowest or preferred

44. The main purpose of the “metal tiers” is to allow consumers to choose a plan based on their:

  • Preferred hospital system
  • Expected healthcare needs and tolerance for financial risk
  • Favorite color
  • Political affiliation


Answer: Expected healthcare needs and tolerance for financial risk

45. Which of the following life events would likely qualify a person for a Special Enrollment Period on the Exchange?

  • Getting a new pet
  • Getting married or having a baby
  • Going on vacation
  • Changing their favorite sports team


Answer: Getting married or having a baby

46. A patient who enrolls in a Silver plan and is eligible for CSRs will have a plan with a(n) ________ actuarial value than a standard Silver plan.

  • lower
  • higher
  • identical
  • unknown


Answer: higher

47. The ACA requires that Exchange plans cover certain preventive services:

  • With a high copayment
  • After the deductible has been met
  • At no cost to the member
  • Only for members under the age of 18


Answer: At no cost to the member

48. A patient complains their new Exchange plan doesn’t cover their long-term medication. The pharmacist should first:

  • Tell the patient there is nothing they can do
  • Verify the drug’s status on the plan’s current formulary and explore alternatives or the exception process
  • Advise the patient to stop taking the medication
  • Immediately switch the medication to a different drug without consulting the prescriber


Answer: Verify the drug’s status on the plan’s current formulary and explore alternatives or the exception process

49. The Health Insurance Marketplace is a key component of what broader system?

  • Managed Care
  • The Veterans Health Administration
  • The pharmaceutical research and development pipeline
  • The Drug Enforcement Administration


Answer: Managed Care

50. For a PharmD student, understanding the Exchanges is ultimately about understanding a major mechanism through which:

  • Patients gain access to care and medications
  • New drugs are invented
  • Pharmacists are licensed
  • Hospitals are accredited


Answer: Patients gain access to care and medications

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