NY independent accident and health insurance
adjuster exam series 17-63 (May ) Questions Latest
Update 2026 (Questions and Answers-Verified
solutions
Social security disability income (aka OASDHI) - CORRECT ANSWERS -disability
related benefits paid through FICA taxes
-amount entitled to is based on earnings over employment years, must have earned a certain # of
quarters of coverage
-must be disabled to the point of not being able to preform any work and it must last at least 12 mo or
result in death
-5 month waiting period before payable
-spouse (50% at 65 or reduced) and children (50%) eligible at % of workers PIA w/ maximum per family
Medicaid - CORRECT ANSWERS -funded by federal and state govs
-for anyone whose income is insufficient to meet the cost of care, must be a certain % under federal
poverty level
Original Medicare - CORRECT ANSWERS -For persons 65+, with CKD, or those
who qualify for social security
-Parts A&B
Medicare Part A - CORRECT ANSWERS -inpatient hospital related services (inpt,
skilled nursing, home health, hospice, inpt psych)
-first 60 days covered completely (minus deductible)
-61-90 reduced benefits
-daily co-payment after this, 1/4 of initial deductible
-compulsory, meaning auto enrolled when applying for soc. sec
,Benefit period (medicare pt A) - CORRECT ANSWERS starts when a patient
enters the hospital and ends when they have been out of the hospital for 60 days
Medicare Part B - CORRECT ANSWERS -pays for physician services, outpatient
hospital services, durable medical equipment, and other services and supplies
-Voluntary, financed through premiums paid by enrollees and the fed gov
-monthly premium and deductible
-After deductible has been met, pt b will cover 80% of expenses and insured pays 20%
Medicare exclusions - CORRECT ANSWERS -Private duty nursing
-Private hospital rooms
-First 3 pints of blood products
-Skilled nursing facility after 100 days
-Unapproved physician charges
-Care outside the US
-Custodial care received at home
-Wellness and preventative exams
Medicare primary and secondary payor - CORRECT ANSWERS -For individuals
eligible for Medicare coverage who continue to work, the employer's health plan would be primary
coverage while Medicare would be secondary coverage
Medicare Part C - CORRECT ANSWERS -"Medicare Advantage"
-health plan options approved by medicare and offered by private insurance companies or managed
care orgs
-PPO, HMO, PFFS, specialty plans
,-Must be enrolled in both A & B to be eligible
Medicare Part D - CORRECT ANSWERS -Prescription drug coverage
-most under C offer prescription drug coverage too
-monthly premium and annual deductible, co-pay after deduct. has been met
-Annual limit
Donut hole - CORRECT ANSWERS -period when benefits are not being paid
-medicare supplement policies known as medi-gap insurance are available for this
High Deductible Health Plans (HDHP) - CORRECT ANSWERS -lower premiums
and higher deductibles than a traditional health plan
-Being covered by an HDHP is a requirement for having a health savings account.
-tax free and collect interest but can only be used for qualified medical expenses
Medical Savings Account (MSA) - CORRECT ANSWERS -employer funded linked
to a HDHP
-high deductible in exchange for a portion of savings being put into MSA
-Can withdraw what is left EOY but taxed
-not been available for newbies since 2007
Health Savings Account (HSA) - CORRECT ANSWERS -must be enrolled in a
HDHP and cannot be enrolled in medicare or claimed on anyone else's tax return
-tax free savings
-roll over to next year if not used in current year
-invested in stocks, bonds, and mutual funds while in the acct
, Flexible Spending Account (FSA) - CORRECT ANSWERS -A salary reduction
cafeteria plan that uses employee funds to provide various types of health care benefits
-lowers cost for employers
-medium to large sized employers use these
Health Reimbursement Accounts (HRA) - CORRECT ANSWERS -tied to high-
deductible policies (HDHP) and most frequently used with them
-funded solely by employer
-unused funds carried over to next year
New York Child Health Plus - CORRECT ANSWERS -must be under 19 and
resident of the state
-eligibility depends on family income
-can enroll if not eligible for medicaid or state health plan
-if covered in last six months, subject to waiting period
-no premium if 1.6 x the poverty level, small monthly for higher incomes, capped at 3 children
-No co-pays
Covered services:
-Well-child visits
-Immz
-Treatment for illness or injury
-Inpt medical or surgical care
-Short term PT OT
-Radiation, chemo, hemodialysis
-Alcohol, substance abuse, and mental health tx
-prescriptions
adjuster exam series 17-63 (May ) Questions Latest
Update 2026 (Questions and Answers-Verified
solutions
Social security disability income (aka OASDHI) - CORRECT ANSWERS -disability
related benefits paid through FICA taxes
-amount entitled to is based on earnings over employment years, must have earned a certain # of
quarters of coverage
-must be disabled to the point of not being able to preform any work and it must last at least 12 mo or
result in death
-5 month waiting period before payable
-spouse (50% at 65 or reduced) and children (50%) eligible at % of workers PIA w/ maximum per family
Medicaid - CORRECT ANSWERS -funded by federal and state govs
-for anyone whose income is insufficient to meet the cost of care, must be a certain % under federal
poverty level
Original Medicare - CORRECT ANSWERS -For persons 65+, with CKD, or those
who qualify for social security
-Parts A&B
Medicare Part A - CORRECT ANSWERS -inpatient hospital related services (inpt,
skilled nursing, home health, hospice, inpt psych)
-first 60 days covered completely (minus deductible)
-61-90 reduced benefits
-daily co-payment after this, 1/4 of initial deductible
-compulsory, meaning auto enrolled when applying for soc. sec
,Benefit period (medicare pt A) - CORRECT ANSWERS starts when a patient
enters the hospital and ends when they have been out of the hospital for 60 days
Medicare Part B - CORRECT ANSWERS -pays for physician services, outpatient
hospital services, durable medical equipment, and other services and supplies
-Voluntary, financed through premiums paid by enrollees and the fed gov
-monthly premium and deductible
-After deductible has been met, pt b will cover 80% of expenses and insured pays 20%
Medicare exclusions - CORRECT ANSWERS -Private duty nursing
-Private hospital rooms
-First 3 pints of blood products
-Skilled nursing facility after 100 days
-Unapproved physician charges
-Care outside the US
-Custodial care received at home
-Wellness and preventative exams
Medicare primary and secondary payor - CORRECT ANSWERS -For individuals
eligible for Medicare coverage who continue to work, the employer's health plan would be primary
coverage while Medicare would be secondary coverage
Medicare Part C - CORRECT ANSWERS -"Medicare Advantage"
-health plan options approved by medicare and offered by private insurance companies or managed
care orgs
-PPO, HMO, PFFS, specialty plans
,-Must be enrolled in both A & B to be eligible
Medicare Part D - CORRECT ANSWERS -Prescription drug coverage
-most under C offer prescription drug coverage too
-monthly premium and annual deductible, co-pay after deduct. has been met
-Annual limit
Donut hole - CORRECT ANSWERS -period when benefits are not being paid
-medicare supplement policies known as medi-gap insurance are available for this
High Deductible Health Plans (HDHP) - CORRECT ANSWERS -lower premiums
and higher deductibles than a traditional health plan
-Being covered by an HDHP is a requirement for having a health savings account.
-tax free and collect interest but can only be used for qualified medical expenses
Medical Savings Account (MSA) - CORRECT ANSWERS -employer funded linked
to a HDHP
-high deductible in exchange for a portion of savings being put into MSA
-Can withdraw what is left EOY but taxed
-not been available for newbies since 2007
Health Savings Account (HSA) - CORRECT ANSWERS -must be enrolled in a
HDHP and cannot be enrolled in medicare or claimed on anyone else's tax return
-tax free savings
-roll over to next year if not used in current year
-invested in stocks, bonds, and mutual funds while in the acct
, Flexible Spending Account (FSA) - CORRECT ANSWERS -A salary reduction
cafeteria plan that uses employee funds to provide various types of health care benefits
-lowers cost for employers
-medium to large sized employers use these
Health Reimbursement Accounts (HRA) - CORRECT ANSWERS -tied to high-
deductible policies (HDHP) and most frequently used with them
-funded solely by employer
-unused funds carried over to next year
New York Child Health Plus - CORRECT ANSWERS -must be under 19 and
resident of the state
-eligibility depends on family income
-can enroll if not eligible for medicaid or state health plan
-if covered in last six months, subject to waiting period
-no premium if 1.6 x the poverty level, small monthly for higher incomes, capped at 3 children
-No co-pays
Covered services:
-Well-child visits
-Immz
-Treatment for illness or injury
-Inpt medical or surgical care
-Short term PT OT
-Radiation, chemo, hemodialysis
-Alcohol, substance abuse, and mental health tx
-prescriptions
