Compliance | By Sonus Benefits,

Test your knowledge about the affordable care act

There has been a great deal of confusion regarding what the Affordable Care Act covers and what is allowable under the law. This is largely due to persistent myths that are propagated by opponents to the reform and word of mouth that has given these myths long legs. See how well you know your facts about the ACA with the following true-false quiz. Then read up on the information accompanying each question.

1) The ACA has strongly discouraged limiting insurance based on pre-existing conditions but stopped short of making this the law.

True _____ False____

False: Under the ACA it is not legal for health insurance companies to deny anyone coverage based on a pre-existing conditions. This is the case even if there was a time in the past before the ACA was passed when you were denied coverage. Being sick cannot be used as a reason to refuse someone health coverage under the law.

2) Although the ACA prohibits insurance companies from covering those with a pre-existing condition they are allowed to charge higher premiums in order to help cover the amount they must pay for an individual’s medical care and treatment.

True____ False____

False: The ACA prohibits discriminatory practices of all kinds. This means that they cannot charge more for people who sign up when they are already undergoing treatment for a condition. Insurance companies receive premiums from individuals whether they are sick or not. They generally make far more in premiums than they have to pay out.

3) There is an exception to the pre-existing condition clause.

True_____ False____

True: Individual health plans that people were on before ACA was passed were grandfathered in and can refuse to cover certain conditions and charge those with pre-existing conditions more than they charge other customers. However, those in grandfathered plans can choose to obtain a different plan through the ACA marketplace and their pre-existing condition will be covered.

4) Part of the ACA’s anti-discriminatory policies involves gender equality.

True____ False____

True: The ACA represents the greatest improvement in health care for women in many years. It prevents insurers from charging women more than men and it closes the “donut hole” in Medicare for women.

5) The ACA increased the age that children can remain on their parent’s health plan from 21 to 23 years of age to improve medical care for young adults who otherwise might not get insurance on their own and because of this, not get care when they need it.

True ____ False____

False: The ACA provides the ability for parents to better protect their children medically by allowing them to remain on their parent’s policy until they are 26 years of age. This is true even if the child is married, lives away from parents, is eligible for an employer’s plan or is fully independent of their parents.

6) The ACA includes a provision that requires employers associated with a religion to pay for birth control with cost to patients.

True_____ False____

True: The ACA recognizes that preventive services pay off in the long run in terms of better health and better prices. The law makes many recommended preventive services mandatory for coverage including mammograms, cervical and colon cancer screenings, pap smears, well checkups, domestic violence evaluations and counseling, and contraception.

7) The ACA gives special privileges to small businesses.

True____ False_____

True: The ACA helps makes it less costly for small businesses to provide health insurance through tax credits to help them buy insurance and to let them join together to get the same lower prices as big corporations.

8) ACA limits benefits for Medicare enrollees.

True_____ False_____

False: Actually, the ACA provides added benefits such as yearly wellness checkups and preventive care without copays for Medicare enrollees.

9) Yearly and lifetime limits under ACA are significantly higher on average than they were prior to healthcare reform being passed.

True___ False___

False: There are no lifetime or yearly limits, meaning that insurance companies cannot set dollar limits on what they spend on a member’s plan over the course of a year or for the entire time the member is enrolled in their plan.

10) The 80/20 rule states that insurance companies must accept a minimum of 80 percent of all those who apply to them for coverage.

True____ False____

False: The 80/20 rule requires that an insurance company spends at least 80 percent of a member’s premium on their health care and activities that improve care. Companies with more than 50 employees are required to spend at least 85 percent on care and improvement of quality of care. If these ratios are not met, the member will receive a premium rebate.


Sonus Benefits have a team of professionals that can help answer your ACA questions. Click here to contact a team member.


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