Health Insurance Final Exam

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Health Insurance Final Exam – Questions and Answers Latest Version Graded A+

What does a copayment mean in health insurance?

• The total monthly premium paid to the insurer

✔✔B) A fixed amount paid by the insured at the time of service

• The maximum amount an insurer will pay in a year
• A refund given by the insurer for unused benefits

What is the primary purpose of a deductible in health insurance?

• To increase the monthly premium
• To set the maximum limit for claims

✔✔C) To require the insured to pay a set amount before coverage begins

• To cover all medical expenses fully

Which government program provides health coverage primarily to low-income individuals?

• Medicare

✔✔B) Medicaid 1 / 4

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C) CHIP

D) TRICARE

What is the meaning of coinsurance in a health insurance policy?

• The total monthly premium
• The amount paid in copayments

✔✔C) The percentage of costs shared by insured and insurer after deductible

• The full amount insurer pays for a claim

What is a formulary in prescription drug coverage?

• A list of approved doctors
• A schedule of hospital services

✔✔C) A list of covered medications

• A list of insurance companies

What is the main characteristic of an HMO (Health Maintenance Organization)?

• No network restrictions
• No need for referrals 2 / 4

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✔✔C) Requires using network providers and referrals to see specialists

• Coverage only for emergencies

What is a health savings account (HSA) used for?

• Paying monthly premiums
• Investing in stocks

✔✔C) Saving tax-free money for qualified medical expenses

• Paying doctor salaries

When can you enroll outside the open enrollment period for health insurance?

• Anytime during the year

✔✔B) After a qualifying life event like marriage or moving

• Only during the first week of January
• When switching jobs regardless of timing

What does an out-of-pocket maximum mean?

• The highest premium you pay yearly

✔✔B) The most you pay in deductibles, copays, and coinsurance before insurance pays 100% 3 / 4

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• The total annual benefit limit
• The monthly copayment amount

What is the role of a primary care physician (PCP) in many insurance plans?

• To perform surgeries only
• To approve insurance claims

✔✔C) To manage overall patient care and provide referrals to specialists

• To set insurance premiums

Which part of Medicare covers prescription drugs?

• Part A
• Part B
• Part C

✔✔D) Part D

What is the difference between PPO and HMO plans?

• PPO plans require referrals; HMOs do not
• PPO plans don’t have networks; HMOs have strict networks
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