POLICY NEWEST 2026 ACTUAL
EXAM| LSUS MHA 708 EXAM A
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SECTION 1: U.S. HEALTHCARE SYSTEM STRUCTURE & FINANCING (
Question 1
Which of the following is the largest source of health insurance coverage in the
United States?
A) Medicare
B) Medicaid
C) Employer-sponsored insurance (ESI)
D) The Affordable Care Act (ACA) Marketplace
Correct Answer: C
,Rationale: Employer-sponsored insurance (ESI) remains the largest source of
health coverage in the U.S., covering approximately 49% of the non-elderly
population. Medicare primarily covers individuals aged 65 and older, while
Medicaid covers low-income populations. The ACA Marketplace covers a smaller
proportion of the population.
Question 2
Medicare Part A covers which of the following?
A) Physician services and outpatient care
B) Hospital inpatient services, skilled nursing facility care, hospice, and some home
health
C) Prescription drugs
D) Preventive services and annual wellness visits
Correct Answer: B
Rationale: Medicare Part A (Hospital Insurance) covers inpatient hospital stays,
skilled nursing facility care, hospice, and some home health care. Part B covers
physician and outpatient services. Part D covers prescription drugs.
Question 3
Medicare Part B covers which of the following?
A) Hospital inpatient services
B) Skilled nursing facility care
C) Physician services and outpatient care
D) Prescription drugs
,Correct Answer: C
Rationale: Medicare Part B (Medical Insurance) covers physician services,
outpatient care, preventive services, and some home health services. Part A covers
inpatient hospital services, and Part D covers prescription drugs.
Question 4
What is the primary purpose of the Federal Medical Assistance Percentage
(FMAP)?
A) To determine the federal matching rate for state Medicaid expenditures
B) To calculate Medicare reimbursement rates for hospitals
C) To establish premium subsidies for ACA Marketplace plans
D) To determine state funding for CHIP programs
Correct Answer: A
Rationale: FMAP is the percentage of Medicaid program costs that the federal
government pays to states. It varies by state based on per capita income, with
wealthier states receiving a lower match rate and poorer states receiving a higher
rate. This is a core concept in understanding the joint federal-state financing of
Medicaid.
Question 5
Which of the following best describes the "donut hole" in Medicare?
A) A gap in Medicare Part A coverage for inpatient hospital stays
B) A coverage gap in Medicare Part D prescription drug plans
, C) A period when Medicare beneficiaries lose all coverage
D) A gap in Medicare Part B coverage for preventive services
Correct Answer: B
Rationale: The Medicare Part D "donut hole" is a coverage gap where beneficiaries
must pay a higher percentage of prescription drug costs after reaching a certain
spending limit and before catastrophic coverage begins. The ACA has been
gradually closing this gap.
Question 6
What are "dual eligibles" in the context of Medicare and Medicaid?
A) Individuals eligible for both Medicare and Medicaid
B) Individuals eligible for two different Medicare Advantage plans
C) Individuals eligible for both employer-sponsored insurance and Medicare
D) Individuals eligible for both CHIP and Medicaid
Correct Answer: A
Rationale: Dual eligibles are individuals who qualify for both Medicare and
Medicaid coverage. These are typically low-income seniors or younger individuals
with disabilities who qualify for Medicare due to age or disability and for Medicaid
due to low income. They represent a particularly vulnerable population with
complex care needs.
Question 7
According to the World Health Organization (WHO), health is defined as: