AHIP - FINAL EXAM 2026
Expert Verifed Ace the Test
Insurer vs Insured - ANSWER ✔✔- insurer is a company that
provides plan
- insured are the people that buy into the plan
Group health insurance - ANSWER ✔✔Health coverage provided by
employers to members of a group.
Group health insurance - types of coverage - ANSWER ✔✔You can
choose among several or just one depending on your employer
* dental, vision, medical benefits, managed care, fee-for-service
insurance
- dental:
,* basic/preventative services, restorative services, comprehensive or
stand-alone, ACA (children, some adults)
- vision:
* basic exams and prescription glasses, ACA (children, some adults)
^ both are employer-sponsored voluntary group plans
Premium tax-credit - ANSWER ✔✔a subsidy that reduces the amount
that consumers must pay
* tax credit that will lower monthly premium based on income and
household info
* advanced premium tax-credit (aptc)
self employed workers - ANSWER ✔✔can deduct health insurance
premiums from their federal taxable income - important tax savings
contracts/health insurance policy - ANSWER ✔✔between insurer and
insured
- consideration: specifically termed agreement w/ promise to do
something in return for a valuable benefit (employer/insured premium
payments to the insurer)
,Covered services - ANSWER ✔✔insurance policy will clearly state
their covered services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - ANSWER ✔✔a situation where insured individuals pay
a portion of the healthcare costs, such as deductibles, coinsurance or
co-payments
- insured is reimbursed for some but not all of the costs
- reimbursement depends on policy
Deductible/coinsurance - ANSWER ✔✔Money paid out of pocket
before insurance covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - ANSWER ✔✔a fixed fee you pay for specific medical
services
government sponsored plans - ANSWER ✔✔federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
COPYRIGHT©PROFFKERRYMARTIN 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
PRIVACY STATEMENT. ALL RIGHTS RESERVED
, employer sponsored plans - ANSWER ✔✔- employer determines
coverage
- company's HR dept answers employee questions
excluded services - ANSWER ✔✔services not covered in a medical
insurance contract like experimental or non-contracted providers,
elective or cosmetic surgery
Health Care Philosophy - ANSWER ✔✔* good quality = cost effective
- more expensive does not mean good healthcare
* cost vs care balance
- good benefits priced appropriately
* less cost, more quality
triangle --> cost, access, quality
*more medical care does not mean better outcomes
managed care improves cost/access/quality - ANSWER ✔✔cost:
limited provider networks, inventing new ways to pay physicians,
requiring referrals for specialty care
Expert Verifed Ace the Test
Insurer vs Insured - ANSWER ✔✔- insurer is a company that
provides plan
- insured are the people that buy into the plan
Group health insurance - ANSWER ✔✔Health coverage provided by
employers to members of a group.
Group health insurance - types of coverage - ANSWER ✔✔You can
choose among several or just one depending on your employer
* dental, vision, medical benefits, managed care, fee-for-service
insurance
- dental:
,* basic/preventative services, restorative services, comprehensive or
stand-alone, ACA (children, some adults)
- vision:
* basic exams and prescription glasses, ACA (children, some adults)
^ both are employer-sponsored voluntary group plans
Premium tax-credit - ANSWER ✔✔a subsidy that reduces the amount
that consumers must pay
* tax credit that will lower monthly premium based on income and
household info
* advanced premium tax-credit (aptc)
self employed workers - ANSWER ✔✔can deduct health insurance
premiums from their federal taxable income - important tax savings
contracts/health insurance policy - ANSWER ✔✔between insurer and
insured
- consideration: specifically termed agreement w/ promise to do
something in return for a valuable benefit (employer/insured premium
payments to the insurer)
,Covered services - ANSWER ✔✔insurance policy will clearly state
their covered services and their exlusions
- proactive, preventative, and reactive services
cost-sharing - ANSWER ✔✔a situation where insured individuals pay
a portion of the healthcare costs, such as deductibles, coinsurance or
co-payments
- insured is reimbursed for some but not all of the costs
- reimbursement depends on policy
Deductible/coinsurance - ANSWER ✔✔Money paid out of pocket
before insurance covers the remaining costs.
% of medical bill that insured pays out of pocket
copay - ANSWER ✔✔a fixed fee you pay for specific medical
services
government sponsored plans - ANSWER ✔✔federal and state gov
* medicare and medicaid
- medicare --> 65+ or younger w/ disabilities or severe kidney problems
- medicaid --> low-income individuals
COPYRIGHT©PROFFKERRYMARTIN 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
PRIVACY STATEMENT. ALL RIGHTS RESERVED
, employer sponsored plans - ANSWER ✔✔- employer determines
coverage
- company's HR dept answers employee questions
excluded services - ANSWER ✔✔services not covered in a medical
insurance contract like experimental or non-contracted providers,
elective or cosmetic surgery
Health Care Philosophy - ANSWER ✔✔* good quality = cost effective
- more expensive does not mean good healthcare
* cost vs care balance
- good benefits priced appropriately
* less cost, more quality
triangle --> cost, access, quality
*more medical care does not mean better outcomes
managed care improves cost/access/quality - ANSWER ✔✔cost:
limited provider networks, inventing new ways to pay physicians,
requiring referrals for specialty care
