RECENT EXAM 2026-2027 ACTUAL COMPLETE REAL EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
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Who is a Primary Care Physician (PCP) or Gatekeeper? -
ANSWER -The doctor who provides first contact, ongoing care,
and referrals to specialists in an
HMO.
What is a PPO? - ANSWER -A managed care plan with a
network of preferred
providers allowing out-of-network care at
higher cost.
What is a Point of Service (POS) plan? - ANSWER -A hybrid
plan combining
HMO and PPO features; subscribers choose at the
time of service.
What are Basic Medical Expense Plans? - ANSWER -Policies
covering non-
hospital medical expenses like office visits, X-rays,
and lab tests.
,What are Basic Hospital Expense Plans? - ANSWER -
Coverage for hospital
room, board, and miscellaneous hospital charges, often
with daily limits.
What is a Major Medical Policy? - ANSWER -A policy with high
limits covering
catastrophic or prolonged illness with deductibles
and coinsurance.
What is a corridor deductible? - ANSWER -An extra
deductible paid after a
basic plan is exhausted and before supplemental major medical
benefits begin.
What is the "carryover provision"? - ANSWER -Expenses in the
last 3 months of
the year can count toward the next year's
deductible.
What coverage must newborn infants have? - ANSWER -
Immediate coverage
from birth including sickness, injury, and congenital defects,
with 31 days to
notify and pay
premium.
Up to what age must dependent children be covered under
federal law? -
,ANSWER -Up to age 26, regardless of student status or
marital status.
Name common health insurance exclusions. - ANSWER -Pre-
existing conditions, suicide, war, elective cosmetic surgery,
Workers' Compensation, military service, government plan
coverage, felony-related injuries.
What is a High Deductible Health Plan (HDHP)? - ANSWER -A
plan with higher
deductibles and lower premiums, often paired with a Health
Savings Account
(HSA).
What is the benefit of combining an HDHP with an HSA? -
ANSWER -Allows
payment of qualified medical expenses with
untaxed funds.
Who is eligible to open an HSA? - ANSWER -Individuals with a
High Deductible
Health Plan
(HDHP).
What are HSAs funded with? - ANSWER -Pre-tax income.
Are HSA funds taxable when used for qualified medical
expenses? - ANSWER -
, No, qualified withdrawals are
tax-free.
Can you contribute to an HSA if you don't have an HDHP? -
ANSWER -No,
contributions require an
HDHP.
What happens to unused HSA funds at year-end? - ANSWER
-They roll over
and accumulate for
future use.
What tax penalties apply for nonqualified withdrawals
before age 65? -
ANSWER -Ordinary income tax plus a
penalty tax.
Can Medicare-eligible individuals contribute to an HSA? -
ANSWER -No, once
eligible for Medicare,
contributions stop.
Who can offer an FSA? - ANSWER -Only employers through
benefit plans.
Can self-employed individuals have an FSA? - ANSWER -No.
How are FSA contributions made? - ANSWER -Pre-tax basis
through salary