Exam (elaborations)
AHM Week 1 Midweek Questions And Answers Latest Update
- Course
- AHM-250
- Institution
- American Military University
AHM Week 1 Midweek Questions And Answers Latest Update
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Q&AAHM Week 1: Midweek Questions And
Answers Latest Update
Federal Poverty Guideline (FPL) - Answers The FPL is a measure of
income set each year by the Department of Health and Human Services. It
helps determine if someone qualifies for subsidies or savings on
Marketplace health insurance.
Health Insurance Marketplace (Exchange) - Answers The Health
Insurance Marketplace, sometimes called an Exchange, is a platform
where individuals can compare and purchase health insurance plans. Each
state has its own Marketplace, and all available plans cover essential
health benefits.
How It Works: The Marketplace offers a selection of insurers and plans,
allowing consumers to choose the coverage that best fits their needs. They
can compare different types of coverage and select the plan that works
best for them and their family.
Open Enrollment Period (OEP): - Answers The yearly period
(November 1 - January 15) when individuals can enroll in a Marketplace
health insurance plan.
Special Enrollment (SEP): - Answers The Special Enrollment Period
(SEP) is a time outside the Open Enrollment Period when individuals can
enroll in a health insurance plan due to a qualifying life event.
, Q&A
Qualifying Life Events (QLE): - Answers Examples include job loss,
birth, divorce, moving to a new state, changes in income, or changes in
family size, such as marriage or having a baby.
SEP for Low-Income Households: - Answers There is an ongoing
Special Enrollment Process (SEP) for households with incomes under
150% of the FPL. For those with incomes over 150% of the FPL, a
Medicaid determination can be submitted. If denied, this can also grant an
SEP.
Subsidies - Answers A subsidy is financial assistance provided by
the federal government to help lower the cost of health insurance for those
purchasing plans through the Marketplace.
Advanced Premium Tax Credit (APTC): - Answers Lowers your
monthly premium payment, reducing your out-of-pocket costs.
Deductible - Answers The amount you must pay for health care
services before your insurance plan starts covering costs.
Maximum Out of Pocket (MOOP): - Answers The most you have to
pay within a year for covered in-network essential health benefits. Once
reached, the plan pays 100% of the allowed amount.
It is the most you will pay out of pocket at $____. If you got a
surgery/treatment/prescriptions you will need to pay only $____. What's
you are done making the payment you are done with making payments for
, Q&A
health services for the year. In some cases most people don't meet that
max out of pocket but you will still be able to have insurance.
Coinsurance - Answers The percentage of costs you pay for a
covered health care service after meeting your deductible.
Copayment - Answers A fixed dollar amount you pay for medical
expenses
Formulary - Answers A list of prescription drugs covered by a
prescription drug plan or insurance plan with prescription drug benefits.
Advanced Premium Tax Credit (APTC) - Answers Definition: A
subsidy that reduces your monthly health insurance premium based on
your estimated yearly income, family size, and health insurance costs in
your area.
How It Works: This subsidy is received ahead of time, helping to make
insurance more affordable from the start.
Cost Sharing Reduction (CSR) - Answers Definition: A discount that
lowers the amount you have to pay for deductibles, copayments, and
coinsurance
How It Works: It is based on your estimated yearly income, family size, and
health insurance costs in your area.
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