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AHIP 2025 Final Exam Test Questions and Answers Updated (Verified Answers)
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AHIP 2025 Final Exam Test Questions and Answers Updated (Verified Answers)
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GREAT DOCUMENT. VERIFIED EXAM QUESTIONS. GREAT VALUE FOR MONEY
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1. Which of the following is typically NOT a feature of a HealthMaintenance Organization (HMO)?
A) Limited network of healthcare providers
B) Requirement for a Primary Care Physician (PCP) referral for specialist
care
C) No need for prior authorization for out-of-network care
D) Emphasis on preventative care
Answer: C) No need for prior authorization for out-of-network care
Rationale: HMOs generally require members to obtain prior
authorization for out-of-network care, and they often restrict coverage
to a specific network of providers. Unlike other plans, such as PPOs,
they emphasize a coordinated approach to care through a Primary Care
Physician (PCP).
2. What is the purpose of the Affordable Care Act (ACA) Marketplace?
A) To provide government-funded health insurance
B) To allow consumers to purchase health insurance through a private
market
C) To offer health insurance plans exclusively for low-income individuals
D) To provide a platform for people to access employer-sponsored
insurance
Answer: B) To allow consumers to purchase health insurance through a
private market
Rationale: The ACA Marketplace (also known as the Health Insurance
Exchange) allows individuals and families to compare and purchase
health insurance plans, often with income-based subsidies. It's not
,solely for low-income individuals but offers options for a wide range of
income levels.
3. Which of the following is a benefit of a Preferred Provider
Organization (PPO) plan?
A) No requirement for a Primary Care Physician (PCP) referral
B) Limited to in-network care only
C) Requires prior authorization for all services
D) Typically lower premiums compared to HMOs
Answer: A) No requirement for a Primary Care Physician (PCP) referral
Rationale: PPO plans offer more flexibility in choosing healthcare
providers and do not require a referral from a Primary Care Physician to
see a specialist. They allow for both in-network and out-of-network
care, though out-of-network care typically incurs higher costs.
4. What does "cost-sharing" in health insurance refer to?
A) The process of determining premium rates
B) The division of responsibility between the insurance company and
the insured for healthcare expenses
C) The total amount an insurance company pays for a healthcare service
D) The method of determining what percentage of a medical service is
covered by Medicare
Answer: B) The division of responsibility between the insurance
company and the insured for healthcare expenses
Rationale: Cost-sharing refers to the portion of healthcare costs that
the insured must pay out of pocket, such as deductibles, copayments,
and coinsurance. The insurer typically covers the remainder.
,5. Which of the following describes the purpose of an insurance
deductible?
A) It is the amount the insured pays for each visit to a healthcare
provider.
B) It is the amount the insured must pay before their insurance plan
begins to pay for covered services.
C) It is the maximum amount the insurance company will pay for a
service.
D) It is the cost of the insurance premium.
Answer: B) It is the amount the insured must pay before their insurance
plan begins to pay for covered services.
Rationale: A deductible is the amount the insured must pay out of
pocket for covered healthcare services before the insurance company
starts to contribute to the costs.
6. Which type of health insurance plan is most likely to have the
highest out-of-pocket costs, but also the greatest flexibility in provider
choice?
A) Health Maintenance Organization (HMO)
B) Exclusive Provider Organization (EPO)
C) Preferred Provider Organization (PPO)
D) High Deductible Health Plan (HDHP)
Answer: C) Preferred Provider Organization (PPO)
Rationale: PPO plans offer the greatest flexibility by allowing members
to see both in-network and out-of-network providers, but this flexibility
, comes at a higher cost, which typically results in higher out-of-pocket
expenses compared to HMO or EPO plans.
7. Which of the following is a common characteristic of Medicaid?
A) It is a federally funded program for low-income individuals.
B) It requires participants to pay premiums.
C) It provides coverage for all U.S. residents regardless of income.
D) It only covers hospital care.
Answer: A) It is a federally funded program for low-income individuals.
Rationale: Medicaid is a joint federal and state program that provides
healthcare coverage for low-income individuals and families, including
those with disabilities. It may also cover services such as long-term care
and rehabilitation.
8. What is the primary purpose of the Health Insurance Portability and
Accountability Act (HIPAA)?
A) To provide health insurance coverage for all U.S. citizens
B) To ensure the privacy and security of health information
C) To regulate insurance premiums
D) To reduce out-of-pocket costs for patients
Answer: B) To ensure the privacy and security of health information
Rationale: HIPAA primarily ensures the protection of individuals' health
information, including the confidentiality, privacy, and security of
personal health data shared between healthcare providers and insurers.
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