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Accurate and Trusted AHIP 2025 Exam Answers for Success R346,73
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Accurate and Trusted AHIP 2025 Exam Answers for Success

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Accurate and Trusted AHIP 2025 Exam Answers for Success

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  • June 11, 2024
  • December 25, 2024
  • 12
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • accurate and trusted ahip 2025 exam answers for su

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3  reviews

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By: alex71 • 5 months ago

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By: TheAlphanurse • 6 months ago

GREAT DOC!! DETAILED ANSWERS. VALUE FOR MONEY HONESTLY. GOOD WORK

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By: kihumba • 6 months ago

GREAT DOCUMENT. VERIFIED EXAM QUESTIONS. GREAT VALUE FOR MONEY

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1. Which of the following is a primary purpose of the Affordable Care
Act (ACA)?
A) To reduce the cost of Medicare premiums
B) To mandate health insurance coverage for all individuals
C) To provide state-specific insurance mandates
D) To eliminate all private insurance plans
Answer: B) To mandate health insurance coverage for all individuals
Rationale: The ACA, also known as Obamacare, primarily aimed to
expand health insurance coverage to a larger portion of the U.S.
population by mandating that individuals must have health insurance,
either through an employer, government program, or private plan. This
individual mandate was a core feature of the ACA until it was effectively
eliminated in 2019 for most people.


2. What is the primary purpose of the Medical Loss Ratio (MLR)
requirement under the ACA?
A) To reduce the number of insured individuals
B) To ensure insurers spend a minimum percentage of premiums on
healthcare services
C) To regulate the prices of medical procedures
D) To eliminate fraud in insurance claims
Answer: B) To ensure insurers spend a minimum percentage of
premiums on healthcare services
Rationale: The ACA requires insurance companies to spend at least 80%
of premiums on healthcare services for individual and small group
policies, and 85% for large group policies. This is known as the Medical

,Loss Ratio (MLR). If insurers fail to meet this requirement, they must
refund the difference to policyholders.


3. Which of the following is a characteristic of a Health Maintenance
Organization (HMO) plan?
A) Members can see specialists without a referral
B) It typically has lower premiums and out-of-pocket costs
C) Out-of-network care is generally covered at a higher rate
D) The plan provides nationwide coverage with any healthcare provider
Answer: B) It typically has lower premiums and out-of-pocket costs
Rationale: HMO plans tend to have lower premiums and out-of-pocket
costs because they use a network of healthcare providers and require
members to get referrals from a primary care physician before seeing
specialists. These plans also focus on preventive care and tend to have
more structured care delivery systems.


4. Under the ACA, which of the following groups is required to have
health insurance coverage or pay a penalty?
A) Individuals over the age of 65
B) All U.S. citizens under the age of 26
C) Most individuals, with some exceptions for financial hardship or
religious objections
D) All low-income individuals eligible for Medicaid
Answer: C) Most individuals, with some exceptions for financial
hardship or religious objections
Rationale: The ACA originally imposed an individual mandate that
required most U.S. citizens to have health insurance or pay a tax

,penalty. However, the penalty was reduced to $0 starting in 2019,
although some states have implemented their own mandates.
Exceptions were made for financial hardship, religious beliefs, and other
specific circumstances.


5. What is the purpose of the Children's Health Insurance Program
(CHIP)?
A) To provide health insurance to low-income individuals over the age
of 65
B) To provide health insurance to children in low-income families
C) To reduce Medicaid premiums for families
D) To create a health insurance marketplace for children
Answer: B) To provide health insurance to children in low-income
families
Rationale: CHIP is a federal and state program that provides low-cost
health coverage to children in families that earn too much to qualify for
Medicaid but cannot afford private health insurance. CHIP covers a wide
range of services, including routine checkups, immunizations, doctor
visits, prescriptions, and dental and vision care.


6. What is an "open enrollment period" in health insurance?
A) A period when you can only switch between Medicaid and private
insurance
B) A time during which individuals can enroll in or change their health
insurance plan without facing a penalty
C) A time when employers must offer health insurance to all employees
D) A time when health insurance premiums are at their lowest

, Answer: B) A time during which individuals can enroll in or change their
health insurance plan without facing a penalty
Rationale: The open enrollment period is the designated time each year
when individuals can sign up for or make changes to their health
insurance plan without facing a penalty. Outside of this period,
individuals can only enroll or make changes if they qualify for a Special
Enrollment Period due to certain life events (e.g., marriage, birth of a
child, or loss of other coverage).


7. Which of the following best describes the function of a high-
deductible health plan (HDHP)?
A) It has lower premiums and higher out-of-pocket costs than
traditional plans
B) It covers all medical expenses without the need for out-of-pocket
payments
C) It requires the use of only in-network providers
D) It limits access to care to prevent overuse of medical services
Answer: A) It has lower premiums and higher out-of-pocket costs than
traditional plans
Rationale: High-deductible health plans (HDHPs) offer lower monthly
premiums but higher deductibles and out-of-pocket costs. These plans
are often paired with Health Savings Accounts (HSAs) that allow
individuals to save pre-tax money for medical expenses. HDHPs are
designed to encourage consumers to shop for healthcare services more
carefully due to the higher out-of-pocket costs.

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