Medicaid (Maryland Health Connection)
Exam UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
Qualified Health Plan - CORRECT ANSWER Health insurance plan offered on Maryland
Health Connection. It is certified by MHC to meet the requirements set forth by the Affordable Care
Act and Maryland Law.
Stand Alone Dental Plan (SADP) - CORRECT ANSWER Dental insurance plan that meets
ACA requirements and include pediatric dental Essential Health Benefits.
Carrier - CORRECT ANSWER A health and/or dental insurance provider.
Cost Sharing - CORRECT ANSWER A consumer's share, or out of pocket amount, of the cost
of their covered services.
Premium - CORRECT ANSWER The amount a consumer pays for their health insurance every
month
Deductible - CORRECT ANSWER Out of pocket amount a consumer must pay each plan year
before insurance begins to pay for services.
Copayment - CORRECT ANSWER Pre-determined rate a consumer must pay for a doctor's
visit, emergency room visit, or a prescription drug purchase.
Coinsurance - CORRECT ANSWER a percentage of the cost of a medical service that a
consumer must pay (rather than a flat rate) with the remainder being picked up by the carrier.
Out of pocket maximum - CORRECT ANSWER the highest amount that a consumer will have
to pay out of pocket in one plan year.
Allowed amount - CORRECT ANSWER The maximum amount a plan will pay for a covered
health care service.
, Exclusions - CORRECT ANSWER Services not covered by an insurance plan. Expenses for
these are not a part of calculating out of pocket maximum.
Open Enrollment - CORRECT ANSWER is a period of time, usually occurring once per year,
when consumers may make changes to their elected fringe benefit options, such as health insurance.
When can households sign up for QHPs and/or SADPs for the first time? - CORRECT
ANSWER During Open Enrollment
Who qualifies for Special Enrollment? - CORRECT ANSWER Consumers who experience
certain life events (getting married, divorced, or having a child)
Special Enrollment - CORRECT ANSWER a certain period of time to enroll in or change
health plans outside of the open enrollment period.
Platinum Coverage - CORRECT ANSWER 90% covered by the insurance company. 10% out
of pocket expense
Gold Coverage - CORRECT ANSWER 80% covered by insurance company. 20% out of pocket
expense
Silver coverage - CORRECT ANSWER 70% covered by insurance company. 30% out of
pocket expense
Bronze coverage - CORRECT ANSWER 60% covered by insurance company. 40% out of
pocket expense
Summary of Benefits and Coverage (SBC) - CORRECT ANSWER Document that concisely
details, in plain language, simple and consistent information about a health plan's benefits and its
coverage of health services.
Difference between QHPs (Qualified Health Program) & SADPs (Stand Alone Dental Plan) -
CORRECT ANSWER Coverage is offered during open enrollment and during qualifying life
Exam UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
Qualified Health Plan - CORRECT ANSWER Health insurance plan offered on Maryland
Health Connection. It is certified by MHC to meet the requirements set forth by the Affordable Care
Act and Maryland Law.
Stand Alone Dental Plan (SADP) - CORRECT ANSWER Dental insurance plan that meets
ACA requirements and include pediatric dental Essential Health Benefits.
Carrier - CORRECT ANSWER A health and/or dental insurance provider.
Cost Sharing - CORRECT ANSWER A consumer's share, or out of pocket amount, of the cost
of their covered services.
Premium - CORRECT ANSWER The amount a consumer pays for their health insurance every
month
Deductible - CORRECT ANSWER Out of pocket amount a consumer must pay each plan year
before insurance begins to pay for services.
Copayment - CORRECT ANSWER Pre-determined rate a consumer must pay for a doctor's
visit, emergency room visit, or a prescription drug purchase.
Coinsurance - CORRECT ANSWER a percentage of the cost of a medical service that a
consumer must pay (rather than a flat rate) with the remainder being picked up by the carrier.
Out of pocket maximum - CORRECT ANSWER the highest amount that a consumer will have
to pay out of pocket in one plan year.
Allowed amount - CORRECT ANSWER The maximum amount a plan will pay for a covered
health care service.
, Exclusions - CORRECT ANSWER Services not covered by an insurance plan. Expenses for
these are not a part of calculating out of pocket maximum.
Open Enrollment - CORRECT ANSWER is a period of time, usually occurring once per year,
when consumers may make changes to their elected fringe benefit options, such as health insurance.
When can households sign up for QHPs and/or SADPs for the first time? - CORRECT
ANSWER During Open Enrollment
Who qualifies for Special Enrollment? - CORRECT ANSWER Consumers who experience
certain life events (getting married, divorced, or having a child)
Special Enrollment - CORRECT ANSWER a certain period of time to enroll in or change
health plans outside of the open enrollment period.
Platinum Coverage - CORRECT ANSWER 90% covered by the insurance company. 10% out
of pocket expense
Gold Coverage - CORRECT ANSWER 80% covered by insurance company. 20% out of pocket
expense
Silver coverage - CORRECT ANSWER 70% covered by insurance company. 30% out of
pocket expense
Bronze coverage - CORRECT ANSWER 60% covered by insurance company. 40% out of
pocket expense
Summary of Benefits and Coverage (SBC) - CORRECT ANSWER Document that concisely
details, in plain language, simple and consistent information about a health plan's benefits and its
coverage of health services.
Difference between QHPs (Qualified Health Program) & SADPs (Stand Alone Dental Plan) -
CORRECT ANSWER Coverage is offered during open enrollment and during qualifying life
