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Guaranteed Passing Score with AHIP 2025 Verified Answers

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Guaranteed Passing Score with AHIP 2025 Verified Answers

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  • June 11, 2024
  • December 25, 2024
  • 10
  • 2023/2024
  • Exam (elaborations)
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1. Which of the following is the primary purpose of the Affordable
Care Act (ACA) in relation to health insurance?
A. To reduce healthcare premiums by increasing competition
B. To mandate that all individuals must buy health insurance
C. To expand Medicaid and provide coverage to uninsured individuals
D. To restrict the use of health savings accounts (HSAs)
Answer: C. To expand Medicaid and provide coverage to uninsured
individuals
Rationale: The ACA's primary purpose is to expand access to healthcare
by providing coverage to uninsured individuals, primarily through
Medicaid expansion and health insurance marketplaces, as well as by
imposing protections like coverage for pre-existing conditions and
essential health benefits.


2. What does the term “pre-existing condition” refer to under the
ACA?
A. A medical condition that must be covered by insurance
B. A condition that existed before an individual applied for health
insurance
C. A medical condition covered only after a waiting period
D. A chronic condition that affects all insured individuals
Answer: B. A condition that existed before an individual applied for
health insurance
Rationale: Under the ACA, insurance companies cannot deny coverage
or charge higher premiums based on pre-existing conditions. A pre-
existing condition refers to a health issue that an individual had before
applying for insurance.

,3. Under Medicare, which part covers prescription drugs?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D. Part D
Rationale: Medicare Part D provides prescription drug coverage. Part A
covers hospital insurance, Part B covers medical insurance (outpatient
care), and Part C is Medicare Advantage, which combines A, B, and
sometimes D.


4. Which of the following best describes a Health Maintenance
Organization (HMO) plan?
A. A plan where members can visit any doctor or specialist without
referrals
B. A plan that requires members to choose a primary care physician
(PCP) and get referrals for specialists
C. A plan with high deductibles and low premiums
D. A plan that provides coverage only for hospital stays
Answer: B. A plan that requires members to choose a primary care
physician (PCP) and get referrals for specialists
Rationale: HMO plans typically require members to select a PCP who
coordinates their care and provides referrals to specialists, ensuring cost
control and a network of providers.


5. What is the primary function of Medicaid?

,A. To provide health coverage to people 65 years and older
B. To offer health insurance for low-income individuals and families
C. To provide coverage for employees of small businesses
D. To support large corporate health insurance plans
Answer: B. To offer health insurance for low-income individuals and
families
Rationale: Medicaid is a joint federal and state program that provides
health coverage for individuals and families with low income, including
pregnant women, children, elderly adults, and people with disabilities.


6. Which of the following is a characteristic of a Preferred Provider
Organization (PPO) plan?
A. Members must use network doctors only
B. Members can see specialists without a referral
C. Members must choose a primary care physician
D. There are no out-of-network benefits
Answer: B. Members can see specialists without a referral
Rationale: PPO plans offer flexibility, allowing members to see any
healthcare provider, including specialists, without a referral. While there
are in-network benefits, members can still go out of network (with
higher out-of-pocket costs).


7. Which of the following is a core benefit of a Health Savings Account
(HSA)?
A. It allows for tax-free withdrawals for medical expenses
B. It is only available to people over the age of 65

, C. It provides insurance coverage for prescription medications
D. It can be used to pay for any medical service without restrictions
Answer: A. It allows for tax-free withdrawals for medical expenses
Rationale: An HSA allows individuals to save money tax-free to pay for
qualified medical expenses. It is typically paired with a high-deductible
health plan (HDHP) and offers both tax deductions on contributions and
tax-free withdrawals for eligible medical expenses.


8. What is the purpose of the Individual Mandate in the ACA
(Affordable Care Act)?
A. To require employers to provide health insurance to all employees
B. To require individuals to purchase health insurance or pay a penalty
C. To limit the premiums charged by insurers
D. To eliminate all exclusions for pre-existing conditions
Answer: B. To require individuals to purchase health insurance or pay a
penalty
Rationale: The ACA originally included an individual mandate, requiring
most Americans to have health insurance or face a tax penalty. This was
intended to encourage healthy individuals to enter the insurance pool,
which helps balance costs.


9. Which of the following best describes catastrophic health insurance
plans?
A. Plans that cover 100% of healthcare expenses
B. Plans with high deductibles that only kick in after very large expenses
C. Plans that cover only routine medical care
D. Plans that offer no coverage for preventive care

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