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AHIP 2025 Exam Verified and Trusted Answers 2024/2025
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Voorbeeld van de inhoud
1. What is the primary goal of the Affordable Care Act (ACA) in termsof health insurance?
A) To reduce the cost of health insurance premiums
B) To eliminate private health insurance companies
C) To increase the number of Americans covered by health insurance
D) To provide government-run health insurance for all Americans
Answer: C) To increase the number of Americans covered by health
insurance
Rationale: The Affordable Care Act was designed to expand health
insurance coverage, reduce the number of uninsured individuals, and
make health insurance more affordable through provisions like
Medicaid expansion and health insurance marketplaces.
2. Under the ACA, which of the following is a requirement for health
insurance plans?
A) To provide coverage for maternity and newborn care
B) To exclude mental health services from coverage
C) To charge individuals based on pre-existing conditions
D) To allow insurance companies to limit lifetime benefits
Answer: A) To provide coverage for maternity and newborn care
Rationale: The ACA mandates that all health insurance plans offered in
the individual and small group markets must include coverage for
essential health benefits, which include maternity and newborn care,
mental health services, and preventive care.
3. Which of the following is a feature of a Health Maintenance
Organization (HMO)?
,A) Members can choose any healthcare provider without needing a
referral.
B) HMO plans require members to have a primary care physician (PCP).
C) HMO plans offer nationwide coverage.
D) Members can see specialists without a referral or network
restrictions.
Answer: B) HMO plans require members to have a primary care
physician (PCP).
Rationale: HMOs typically require members to choose a PCP, who acts
as a gatekeeper for referrals to specialists. This model is designed to
reduce costs and coordinate care more efficiently within a network.
4. Which of the following types of health insurance plans generally
offers the most flexibility in choosing healthcare providers?
A) Health Maintenance Organization (HMO)
B) Preferred Provider Organization (PPO)
C) Exclusive Provider Organization (EPO)
D) Point of Service (POS)
Answer: B) Preferred Provider Organization (PPO)
Rationale: PPOs offer greater flexibility than HMOs, allowing members
to see out-of-network providers, although at a higher cost. Members
don’t need a referral to see a specialist, which provides more freedom
in choosing healthcare providers.
5. Which of the following is an example of a government-funded
health insurance program?
,A) Health Savings Account (HSA)
B) Medicare
C) Preferred Provider Organization (PPO)
D) Health Maintenance Organization (HMO)
Answer: B) Medicare
Rationale: Medicare is a government-funded program that provides
health insurance to individuals aged 65 and older, as well as certain
younger individuals with disabilities or chronic conditions.
6. What is the purpose of the Health Insurance Marketplace (also
known as the Exchange)?
A) To provide free healthcare to low-income individuals
B) To help individuals and small businesses compare and purchase
health insurance
C) To offer government-run health insurance exclusively
D) To collect premiums for Medicare
Answer: B) To help individuals and small businesses compare and
purchase health insurance
Rationale: The Health Insurance Marketplace allows individuals and
small businesses to compare various health insurance plans and apply
for subsidies based on their income to make insurance more affordable.
7. In which of the following scenarios would a person likely qualify for
Medicaid coverage?
A) A low-income individual who is over the age of 65
B) A person with a disability who has low income
, C) A middle-income family with children
D) An individual who earns $50,000 annually
Answer: B) A person with a disability who has low income
Rationale: Medicaid is a joint federal and state program designed to
provide health coverage to low-income individuals, including those with
disabilities, children, pregnant women, and some elderly individuals.
8. Which of the following is NOT considered an essential health
benefit under the ACA?
A) Emergency services
B) Prescription drugs
C) Cosmetic surgery
D) Mental health services
Answer: C) Cosmetic surgery
Rationale: The ACA requires health insurance plans to cover essential
health benefits, including emergency services, prescription drugs, and
mental health services. Cosmetic surgery, unless medically necessary, is
not considered an essential health benefit.
9. What does the term "network" refer to in health insurance plans?
A) A group of healthcare providers who are contracted with the
insurance company
B) A government program for low-income individuals
C) The amount of money a person must pay for health services
D) The process by which insurance companies process claims
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