Medical Expense Practice Questions

702 free medical expense questions for the California Life & Health insurance license exam. Pick any question — answer it and get the full 3-part explanation, no signup required.

1. 1.An employer establishes a Health Reimbursement Arrangement (HRA) for its employees. Which statement correct…
   Difficulty 2/5
2. 2.A Point-of-Service (POS) plan is best described as:
   Difficulty 2/5
3. 3.Under the Affordable Care Act, the 'guaranteed issue' requirement for small group health plans means that:
   Difficulty 1/5
4. 4.Under COBRA, a dependent child who loses coverage because of 'aging out' of the parent's group plan may con…
   Difficulty 1/5
5. 5.To enroll in a stand-alone Medicare Part D prescription drug plan, a beneficiary must have:
   Difficulty 1/5
6. 6.CMS 'Secret Shopper' activities are used to:
   Difficulty 2/5
7. 7.The annual out-of-pocket maximum in a health plan is best defined as:
   Difficulty 2/5
8. 8.Which managed care technique controls health care costs by evaluating the medical necessity of planned serv…
   Difficulty 2/5
9. 9.Medical expense policies generally exclude coverage for:
   Difficulty 2/5
10. 10.A point-of-service (POS) plan is best described as a plan that:
    Difficulty 2/5
11. 11.In the individual and small-group health insurance market, coverage for adult dental and vision services is…
    Difficulty 1/5
12. 12.Which of the following counts as 'minimum essential coverage' (MEC)?
    Difficulty 1/5
13. 13.A point-of-service (POS) plan combines features of an HMO and a PPO. Which statement correctly describes a …
    Difficulty 2/5
14. 14.For large group medical plans, insurers typically set premiums using:
    Difficulty 2/5
15. 15.A physician who 'accepts assignment' under Medicare agrees to:
    Difficulty 3/5
16. 16.An HMO pays a primary care physician a fixed amount each month for every member assigned to that physician,…
    Difficulty 2/5
17. 17.For a beneficiary who missed the Initial Enrollment Period and has no Special Enrollment Period, the Medica…
    Difficulty 2/5
18. 18.A point-of-service (POS) health plan combines features of which two managed care delivery models?
    Difficulty 2/5
19. 19.A point-of-service (POS) plan is best described as a managed care model that:
    Difficulty 2/5
20. 20.Under CMS marketing rules, a sales call made by a telephonic marketing organization (TPMO) must include:
    Difficulty 2/5
21. 21.A person who has fewer than 30 quarters of Medicare-covered work may enroll in Medicare Part A by:
    Difficulty 2/5
22. 22.In a staff model HMO, the physicians who provide care to members are typically:
    Difficulty 2/5
23. 23.A D-SNP (Dual-Eligible Special Needs Plan) is a Medicare Advantage plan designed for individuals who are:
    Difficulty 2/5
24. 24.The Medicare Part B monthly premium for a beneficiary with higher income is:
    Difficulty 2/5
25. 25.An 'extension of benefits' provision in a medical expense policy generally:
    Difficulty 3/5
26. 26.A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is:
    Difficulty 3/5
27. 27.A member of a Point-of-Service (POS) health plan wants to see a specialist who is outside the plan's networ…
    Difficulty 1/5
28. 28.The Mental Health Parity and Addiction Equity Act requires group plans to:
    Difficulty 2/5
29. 29.Which service is covered under Medicare Part A?
    Difficulty 2/5
30. 30.Under Medicare Part D rules, a plan's formulary must include:
    Difficulty 1/5
31. 31.A beneficiary who disagrees with a claim decision under Original Medicare begins the appeal process with:
    Difficulty 1/5
32. 32.Under the staff model of an HMO, the physicians who treat members are:
    Difficulty 1/5
33. 33.A beneficiary who is enrolled in a Medicare Advantage plan and also owns a Medigap policy:
    Difficulty 2/5
34. 34.Which of the following is a type of Medicare Advantage (Part C) plan?
    Difficulty 2/5
35. 35.The Medicare Summary Notice (MSN) is best described as:
    Difficulty 1/5
36. 36.Community rating, the method typically used for small groups, means that premiums are:
    Difficulty 2/5
37. 37.Which statement correctly describes a point-of-service (POS) plan?
    Difficulty 2/5
38. 38.A primary purpose of the Patient Protection and Affordable Care Act (PPACA) is to:
    Difficulty 1/5
39. 39.A Special Enrollment Period (SEP) for Medicare Part B is available while a person is covered by an employer…
    Difficulty 2/5
40. 40.A lawful resident of the United States who is not a citizen qualifies for Medicare at age 65 if he or she h…
    Difficulty 1/5
41. 41.A health insurance policy that is 'guaranteed renewable' permits the insurer to:
    Difficulty 2/5
42. 42.A point-of-service (POS) plan is best described as a managed care arrangement that:
    Difficulty 2/5
43. 43.Which statement correctly describes a Health Reimbursement Arrangement (HRA)?
    Difficulty 2/5
44. 44.A Qualified Health Plan (QHP) is defined as:
    Difficulty 2/5
45. 45.Which of the following is one of the categories of essential health benefits (EHBs) that individual and sma…
    Difficulty 2/5
46. 46.A point-of-service (POS) plan blends features of which two managed care arrangements?
    Difficulty 2/5
47. 47.In an HMO, a primary care physician is typically compensated through capitation, which means the physician …
    Difficulty 2/5
48. 48.Under HIPAA, an individual's 'creditable coverage' is used to:
    Difficulty 2/5
49. 49.The primary purpose of a major medical expense insurance policy is to protect the insured against:
    Difficulty 1/5
50. 50.Cost-sharing reductions (CSR) under the ACA are available to eligible enrollees whose household income is b…
    Difficulty 2/5