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Life and Health Insurance Producer Exam

Medical expense plans: practice questions

Our Life & Health Insurance bank has 10 questions on this topic. Here are 5 of them with answers; the full mock exam draws from every topic, like the real one.

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Question 1

How are HMO providers commonly paid?

  1. By fee-for-service: a fee for each service provided
  2. By capitation: a fixed amount per member per month
  3. By the patient directly, with no insurer involved
  4. By salary from the federal government
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B. By capitation: a fixed amount per member per month — Capitation encourages preventive care.

Question 2

What is an exclusive provider organization (EPO)?

  1. A plan offered only to exclusive executive employees
  2. A plan that covers any provider with no network at all and no out-of-pocket limits
  3. A plan that covers care only from network providers, except emergencies
  4. A plan that pays a fixed amount per day in hospital
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C. A plan that covers care only from network providers, except emergencies — It is like a PPO without out-of-network coverage.

Question 3

What is the ACA's open enrollment period used for?

  1. Changing the beneficiary on a life insurance policy without the beneficiary's consent
  2. Enrolling in or changing marketplace plans for the next year
  3. Filing claims for last year's medical bills
  4. Applying for Medicare Part A for the first time
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B. Enrolling in or changing marketplace plans for the next year — Special enrollment periods follow qualifying life events.

Question 4

Until what age may young adults stay on a parent's health plan under the ACA?

  1. Age 26
  2. Age 18
  3. Age 21
  4. Age 30
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A. Age 26 — This applies to plans that offer dependent coverage.

Question 5

What are the ACA metal levels based on?

  1. The insurer's financial strength rating from independent rating agencies
  2. The age of the people enrolled in the plan
  3. The share of average costs the plan pays (actuarial value)
  4. The number of doctors in the plan's network
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C. The share of average costs the plan pays (actuarial value) — Bronze ~60%, silver ~70%, gold ~80%, platinum ~90%.

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