AHIP Final Exam Practice Test –
Questions and answers with solutions
1. What is the primary goal of Medicare?
A. Provide health insurance to children
B. Provide health insurance to older adults and certain disabled individuals
C. Fund private insurance companies
D. Provide long-term care only
Answer: B
Rationale: Medicare is a federal program primarily designed to provide health coverage for
adults aged 65+ and certain disabled individuals.
2. Which of the following is a type of Medicare Advantage Plan?
A. HMO
B. PPO
C. Private Fee-for-Service
D. All of the above
Answer: D
Rationale: Medicare Advantage plans can include HMO, PPO, PFFS, and other managed care
options.
3. What does the term “premium” refer to in health insurance?
A. The amount paid when receiving care
B. The amount paid periodically to maintain insurance coverage
C. The deductible amount
D. A penalty for late payment
Answer: B
Rationale: The premium is the regular payment made to keep an insurance policy active.
,4. Which program provides health coverage for low-income individuals and
families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: B
Rationale: Medicaid is a state and federally funded program providing coverage to low-income
populations.
5. What is the purpose of a copayment?
A. To cover the full cost of care
B. To share the cost of care between the patient and insurer
C. To pay the premium
D. To penalize patients for overuse
Answer: B
Rationale: Copayments require the patient to pay a fixed amount for a service, while the insurer
covers the remainder.
6. In insurance terms, what is a deductible?
A. Monthly premium
B. Amount paid by the patient before insurance coverage begins
C. Amount insurance pays after claim
D. Penalty for missed appointments
Answer: B
7. Which of the following is true about Medicare Part B?
A. Covers hospital stays
B. Covers outpatient services and physician visits
C. Only covers prescription drugs
D. Is automatically free
, Answer: B
8. Which insurance program is specifically for military personnel and their
families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: C
9. What is the purpose of a formulary in health insurance?
A. List of covered medications
B. Billing code directory
C. Physician directory
D. Premium schedule
Answer: A
10. What does CMS stand for?
A. Centers for Medical Safety
B. Centers for Medicare & Medicaid Services
C. Clinical Management System
D. Care Management Services
Answer: B
11. What is an out-of-pocket maximum?
A. Maximum premium paid annually
B. Maximum a patient pays before insurance covers 100%
C. Maximum deductible
D. Maximum co-pay per visit
Answer: B
Questions and answers with solutions
1. What is the primary goal of Medicare?
A. Provide health insurance to children
B. Provide health insurance to older adults and certain disabled individuals
C. Fund private insurance companies
D. Provide long-term care only
Answer: B
Rationale: Medicare is a federal program primarily designed to provide health coverage for
adults aged 65+ and certain disabled individuals.
2. Which of the following is a type of Medicare Advantage Plan?
A. HMO
B. PPO
C. Private Fee-for-Service
D. All of the above
Answer: D
Rationale: Medicare Advantage plans can include HMO, PPO, PFFS, and other managed care
options.
3. What does the term “premium” refer to in health insurance?
A. The amount paid when receiving care
B. The amount paid periodically to maintain insurance coverage
C. The deductible amount
D. A penalty for late payment
Answer: B
Rationale: The premium is the regular payment made to keep an insurance policy active.
,4. Which program provides health coverage for low-income individuals and
families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: B
Rationale: Medicaid is a state and federally funded program providing coverage to low-income
populations.
5. What is the purpose of a copayment?
A. To cover the full cost of care
B. To share the cost of care between the patient and insurer
C. To pay the premium
D. To penalize patients for overuse
Answer: B
Rationale: Copayments require the patient to pay a fixed amount for a service, while the insurer
covers the remainder.
6. In insurance terms, what is a deductible?
A. Monthly premium
B. Amount paid by the patient before insurance coverage begins
C. Amount insurance pays after claim
D. Penalty for missed appointments
Answer: B
7. Which of the following is true about Medicare Part B?
A. Covers hospital stays
B. Covers outpatient services and physician visits
C. Only covers prescription drugs
D. Is automatically free
, Answer: B
8. Which insurance program is specifically for military personnel and their
families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: C
9. What is the purpose of a formulary in health insurance?
A. List of covered medications
B. Billing code directory
C. Physician directory
D. Premium schedule
Answer: A
10. What does CMS stand for?
A. Centers for Medical Safety
B. Centers for Medicare & Medicaid Services
C. Clinical Management System
D. Care Management Services
Answer: B
11. What is an out-of-pocket maximum?
A. Maximum premium paid annually
B. Maximum a patient pays before insurance covers 100%
C. Maximum deductible
D. Maximum co-pay per visit
Answer: B
