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AAPC CPB Final Exam — 100 Practice Questions & Answers (2026–2027)
Section 1: Types of Insurance (Questions 1–20)
1. A 6-year-old is seen in the pediatrician's office for the first time. He has insurance
coverage through both his mother (DOB: 02/08/86) and his father (DOB: 05/15/85).
Whose insurance is primary?
A) Mother's insurance plan
B) Father's insurance plan
C) The policy with the best benefits
D) Either plan depending on who brings the child in
Answer: A. Under the Birthday Rule, the parent whose birthday falls earlier in the calendar
year has the primary plan for dependent children .
2. Which Medicare Part covers inpatient hospital care?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: A. Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and
some home health care .
3. A patient has a Medicare Advantage plan. This is also known as:
A) Part A
B) Part B
C) Part C
D) Part D
Answer: C. Medicare Advantage (Part C) is offered by private insurers approved by Medicare
to provide Part A and Part B benefits .
4. Which of the following is a characteristic of an HMO?
A) Patients may see any provider they choose
B) Patients must use in-network providers except in emergencies
C) There is no primary care physician requirement
D) Out-of-network care is always covered at the same rate
Answer: B. HMOs require patients to use network providers and typically require a PCP
referral for specialists .
5. TRICARE provides health coverage for:
A) Federal employees
B) Military personnel and their families
, 2
C) Low-income individuals
D) Senior citizens
Answer: B. TRICARE covers active duty service members, retirees, and their families .
6. Workers' compensation insurance covers:
A) All medical conditions regardless of cause
B) Work-related injuries and illnesses
C) Only injuries that occur in an office
D) Only injuries caused by employer negligence
Answer: B. Workers' compensation covers medical costs and lost wages for work-related
injuries and illnesses .
7. Under a capitation payment model, a provider is paid:
A) For each service performed
B) A fixed amount per patient per month regardless of services provided
C) A percentage of billed charges
D) A bonus for high patient satisfaction
Answer: B. Capitation pays a fixed per-member-per-month amount regardless of utilization .
8. An EPO (Exclusive Provider Organization) differs from an HMO because:
A) It requires a PCP referral
B) It does not require a PCP referral but generally does not cover out-of-network care
C) It covers out-of-network care at the same rate
D) It is only available through Medicare
Answer: B. EPOs typically do not require PCP referrals but provide no out-of-network
coverage except emergencies .
9. Medicaid is administered by:
A) The federal government exclusively
B) State governments with federal oversight and funding
C) Private insurance companies
D) The Department of Defense
Answer: B. Medicaid is a joint federal-state program administered by states within federal
guidelines .
10. Medigap policies are designed to:
A) Replace Medicare coverage
B) Cover gaps in Medicare coverage such as copayments and deductibles
C) Provide prescription drug coverage
D) Cover only hospital care
, 3
Answer: B. Medigap (Medicare Supplement) policies cover cost-sharing gaps in Original
Medicare .
11. A patient has both Medicare and a commercial retiree plan. Which is generally
primary?
A) The commercial retiree plan
B) Medicare
C) The plan with the lower premium
D) The plan chosen by the patient
Answer: B. Medicare is generally primary for retirees with employer-sponsored coverage
unless the employer has 20+ employees and the patient is still actively working .
12. Which of the following is a consumer-driven health plan?
A) HMO
B) PPO
C) Health Savings Account (HSA) paired with a high-deductible health plan
D) POS
Answer: C. Consumer-driven health plans pair high-deductible plans with tax-advantaged
savings accounts like HSAs .
13. A deductible is:
A) The amount paid at each visit
B) The amount the patient pays before insurance begins to pay
C) A percentage of the bill the patient pays
D) A monthly premium
Answer: B. A deductible is the amount the patient must pay out-of-pocket before insurance
coverage begins .
14. Coinsurance is:
A) A fixed dollar amount per visit
B) A percentage of covered charges the patient pays after the deductible
C) A monthly payment for insurance
D) The maximum the insurer will pay
Answer: B. Coinsurance is the patient's percentage share of covered costs after the
deductible is met .
15. A copayment is:
A) A fixed dollar amount paid at the time of service
B) A percentage of the bill
C) The annual deductible
D) The monthly premium
AAPC CPB Final Exam — 100 Practice Questions & Answers (2026–2027)
Section 1: Types of Insurance (Questions 1–20)
1. A 6-year-old is seen in the pediatrician's office for the first time. He has insurance
coverage through both his mother (DOB: 02/08/86) and his father (DOB: 05/15/85).
Whose insurance is primary?
A) Mother's insurance plan
B) Father's insurance plan
C) The policy with the best benefits
D) Either plan depending on who brings the child in
Answer: A. Under the Birthday Rule, the parent whose birthday falls earlier in the calendar
year has the primary plan for dependent children .
2. Which Medicare Part covers inpatient hospital care?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: A. Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and
some home health care .
3. A patient has a Medicare Advantage plan. This is also known as:
A) Part A
B) Part B
C) Part C
D) Part D
Answer: C. Medicare Advantage (Part C) is offered by private insurers approved by Medicare
to provide Part A and Part B benefits .
4. Which of the following is a characteristic of an HMO?
A) Patients may see any provider they choose
B) Patients must use in-network providers except in emergencies
C) There is no primary care physician requirement
D) Out-of-network care is always covered at the same rate
Answer: B. HMOs require patients to use network providers and typically require a PCP
referral for specialists .
5. TRICARE provides health coverage for:
A) Federal employees
B) Military personnel and their families
, 2
C) Low-income individuals
D) Senior citizens
Answer: B. TRICARE covers active duty service members, retirees, and their families .
6. Workers' compensation insurance covers:
A) All medical conditions regardless of cause
B) Work-related injuries and illnesses
C) Only injuries that occur in an office
D) Only injuries caused by employer negligence
Answer: B. Workers' compensation covers medical costs and lost wages for work-related
injuries and illnesses .
7. Under a capitation payment model, a provider is paid:
A) For each service performed
B) A fixed amount per patient per month regardless of services provided
C) A percentage of billed charges
D) A bonus for high patient satisfaction
Answer: B. Capitation pays a fixed per-member-per-month amount regardless of utilization .
8. An EPO (Exclusive Provider Organization) differs from an HMO because:
A) It requires a PCP referral
B) It does not require a PCP referral but generally does not cover out-of-network care
C) It covers out-of-network care at the same rate
D) It is only available through Medicare
Answer: B. EPOs typically do not require PCP referrals but provide no out-of-network
coverage except emergencies .
9. Medicaid is administered by:
A) The federal government exclusively
B) State governments with federal oversight and funding
C) Private insurance companies
D) The Department of Defense
Answer: B. Medicaid is a joint federal-state program administered by states within federal
guidelines .
10. Medigap policies are designed to:
A) Replace Medicare coverage
B) Cover gaps in Medicare coverage such as copayments and deductibles
C) Provide prescription drug coverage
D) Cover only hospital care
, 3
Answer: B. Medigap (Medicare Supplement) policies cover cost-sharing gaps in Original
Medicare .
11. A patient has both Medicare and a commercial retiree plan. Which is generally
primary?
A) The commercial retiree plan
B) Medicare
C) The plan with the lower premium
D) The plan chosen by the patient
Answer: B. Medicare is generally primary for retirees with employer-sponsored coverage
unless the employer has 20+ employees and the patient is still actively working .
12. Which of the following is a consumer-driven health plan?
A) HMO
B) PPO
C) Health Savings Account (HSA) paired with a high-deductible health plan
D) POS
Answer: C. Consumer-driven health plans pair high-deductible plans with tax-advantaged
savings accounts like HSAs .
13. A deductible is:
A) The amount paid at each visit
B) The amount the patient pays before insurance begins to pay
C) A percentage of the bill the patient pays
D) A monthly premium
Answer: B. A deductible is the amount the patient must pay out-of-pocket before insurance
coverage begins .
14. Coinsurance is:
A) A fixed dollar amount per visit
B) A percentage of covered charges the patient pays after the deductible
C) A monthly payment for insurance
D) The maximum the insurer will pay
Answer: B. Coinsurance is the patient's percentage share of covered costs after the
deductible is met .
15. A copayment is:
A) A fixed dollar amount paid at the time of service
B) A percentage of the bill
C) The annual deductible
D) The monthly premium
