Florida Medicare Insurance Specialist Practice
Exam 2026 | Based on NAIFA-Florida 36th
Edition | Released Lately for 2025/2026
Academic Year - Pass on Your First Attempt
and Avoid Resits
Expenses such as rent, utilities, telephone, equipment,
employees' salaries, etc.) All of the following are state or
federal government programs that provide health
insurance, EXCEPT? -Medicare -OASDI disability -
Medicaid -Medigap - ANSWER//Medigap (Explanation:A
Medigap policy is a Medicare supplement insurance policy
sold by private insurance companies to fill "gaps" in
Medicare Parts A and B.) What type of health insurance is
available to assist low-income individuals? -
ANSWER//Medicaid What types of reserves are set aside
and held by health insurance companies? -
ANSWER//Premium and Claims reserves
(Explanation:Reserves are set aside for the payment of
future claims.) Group health insurance is generally written
on a basis that provides for dividends or experience rating.
What is the basis called? - ANSWER//Participating
(Explanation:Group plans written by mutual companies
provide for dividends while stock companies frequently
issue experience-rated plans.) Which of the following is
NOT TRUE regarding eligibility for subsidies for families
under the new health care act? -For those who make
between 100-400% of the Federal Poverty -Level -Cannot
be covered by an employer -Cannot be eligible for
Medicare -Can be eligible for Medicaid - ANSWER//Can
be eligible for Medicaid Which of the following operates as
a corporation, society, or association to provide life
insurance primarily for the mutual benefit of its members,
has a lodge or social system with rituals and
representative form of government? A) Mutual companies
B) Fraternal associations C) Stock companies -Fraternal
benefit society - ANSWER//B) Fraternal associations What
,does each member pay in a typical HMO plan? -Fixed
premium based on a deductible and copay -Fixed
premium whether or not plan is used -Premium based on
how often plan is used - ANSWER//Fixed premium
whether or not plan is used Which of the following is
correct about those who are eligible for Medicare and wish
to join an HMO? -They must have a current Medicare
supplement policy -They must be told that'll be getting all
the benefits from the Medicare Advantage plan -They
must be age 70 and above -They must have been enrolled
previously in an HMO - ANSWER//They must be told that'll
be getting all the benefits from the Medicare Advantage
plan Joyce is totally disabled. Her HMO policy just
terminated. All of the following are correct regarding
"extension of benefits" for Joyce, EXCEPT? -Coverage
ends once maximum benefits have been exhausted -
Coverage ends once another carrier assumes coverage -
Coverage ends if no longer totally disabled -Coverage
ends after 18 months - ANSWER//Coverage ends after 18
months All of the following are correct regarding Florida
regulation of HMOs, EXCEPT? -Must obtain a Certificate
of Authority -Must file a report of its activities within 3
months of the end of each fiscal year -Must deposit
$100,000 with the Rehabilitation Administration Expense
Fund -Must be sold by agents licensed and appointed as
health insurance agents - ANSWER//Must deposit
$100,000 with the Rehabilitation Administration Expense
Fund (Explanation: They must deposit $10,000 with the
Rehabilitation Administration Expense Fund.) What is
"capitation" as it relates to an HMO? -Amount to be
collected by the HMO from participating health care
providers -Fixed amount paid by an HMO during a policy
period -Fixed amount paid by an HMO to a physician for
medical services -Amount required to be deposited with
the State of Florida - ANSWER//Fixed amount paid by an
HMO to a physician for medical services When a person is
covered by an HMO, the contract certificate or member's
,handbook must be delivered within how many days after
approval of the enrollment by the HMO? -20 days -10
days -5 days -14 days - ANSWER//10 days Which of the
following statements about health service organizations is
true? -They reimburse Policyowners directly for
physicians' fees -They provide loss of income benefits to
Policyowners -They reimburse Policyowners directly for all
medical expenses -They provide benefit payments directly
to the hospitals and physicians providing services -
ANSWER//They provide benefit payments directly to the
hospitals and physicians providing services What is the
period of time for an HMO "open enrollment"? -45 days
during every 18-month period -30 days during every 12-
month period -30 days during every 18-month period -45
days during every 12-month period - ANSWER//30 days
during every 18-month period If an HMO is found guilty of
unfair trade practices, what is the maximum penalty that
can be charged? -Up to $50,000 -Up to $150,000 -Up to
$200,00 -Up to $100,000 - ANSWER//Up to $200,00
Which of the following statements about Worker's
Compensation laws is INCORRECT? -Employers can
purchase coverage through the state program, private
insurers or can self-insure -Worker's compensation
provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law -Basic
principle is that work-related injuries are compensable by
the employer without regard to fault - ANSWER//Not all
states have a workers compensation law What year was
the Social Security Act amended to add health insurance
protection for the aged and disabled? -1973 -1965 -1985 -
1935 - ANSWER//1965 All of the following are true
statements about Workers Compensation, EXCEPT..? -
Benefits are not paid unless there is employer negligence
-Pays benefits for work related injuries and illnesses -
Employee does not contribute to the plan -All states have
Workers Compensation laws - ANSWER//Benefits are not
paid unless there is employer negligence Which of the
, following is a state administered disability plan? -Social
Security -Workers Compensation -Medigap -Medicare -
ANSWER//Workers Compensation All of the following are
nontraditional methods of providing health insurance,
EXCEPT? -Multiple Employer Trusts -Multiple Employer
Welfare Arrangements -Self-insurance -Commercial
insurers - ANSWER//Commercial insurers All of the
following are true about a multiple employer welfare
arrangement (MEWA), EXCEPT? -Required by law to
have an employment-related common bond -Often provide
insurance on a self-insured basis -Tax-exempt entities -
Large employers who have joined together to provide
health insurance benefits - ANSWER//Large employers
who have joined together to provide health insurance
benefits (Explanation: MEWAs consist of small employers
who join together to provide health insurance benefits for
their employees) Grouping small businesses together to
obtain health insurance as one large group is a
characteristic of what type of group? -Multiple Employer
Trust (MET) -Franchise Health plan -Health Maintenance
Organization (HMO) -Blue Cross/Blue Shield -
ANSWER//Multiple Employer Trust (MET) Casey has a
medical expense policy that provides a fixed rate of $150
per day for hospitalization. Casey is hospitalized for 10
days and incurred covered medical expenses of $20,000.
What will her medical expense policy pay? -$1,500 -
$20,000 -$15,000 -$3,000 - ANSWER//$1,500
(Explanation: Casey's policy will only cover a fixed rate per
day for hospitalization of $150. If she is hospitalized for 10
days, then her policy will pay $1,500 ($150 x 10) of the
total $20,000 in expenses.) Jamie has a reimbursement
type medical expense policy with a maximum benefit of
$500,000. She is hospitalized and incurs $25,000 in
covered medical expenses. What will her policy provide in
coverage? -$20,000 -$25,000 -$10,000 -$12,500 -
ANSWER//$25,000 (Explanation: A reimbursement type
policy will provide coverage for expenses incurred. In this
Exam 2026 | Based on NAIFA-Florida 36th
Edition | Released Lately for 2025/2026
Academic Year - Pass on Your First Attempt
and Avoid Resits
Expenses such as rent, utilities, telephone, equipment,
employees' salaries, etc.) All of the following are state or
federal government programs that provide health
insurance, EXCEPT? -Medicare -OASDI disability -
Medicaid -Medigap - ANSWER//Medigap (Explanation:A
Medigap policy is a Medicare supplement insurance policy
sold by private insurance companies to fill "gaps" in
Medicare Parts A and B.) What type of health insurance is
available to assist low-income individuals? -
ANSWER//Medicaid What types of reserves are set aside
and held by health insurance companies? -
ANSWER//Premium and Claims reserves
(Explanation:Reserves are set aside for the payment of
future claims.) Group health insurance is generally written
on a basis that provides for dividends or experience rating.
What is the basis called? - ANSWER//Participating
(Explanation:Group plans written by mutual companies
provide for dividends while stock companies frequently
issue experience-rated plans.) Which of the following is
NOT TRUE regarding eligibility for subsidies for families
under the new health care act? -For those who make
between 100-400% of the Federal Poverty -Level -Cannot
be covered by an employer -Cannot be eligible for
Medicare -Can be eligible for Medicaid - ANSWER//Can
be eligible for Medicaid Which of the following operates as
a corporation, society, or association to provide life
insurance primarily for the mutual benefit of its members,
has a lodge or social system with rituals and
representative form of government? A) Mutual companies
B) Fraternal associations C) Stock companies -Fraternal
benefit society - ANSWER//B) Fraternal associations What
,does each member pay in a typical HMO plan? -Fixed
premium based on a deductible and copay -Fixed
premium whether or not plan is used -Premium based on
how often plan is used - ANSWER//Fixed premium
whether or not plan is used Which of the following is
correct about those who are eligible for Medicare and wish
to join an HMO? -They must have a current Medicare
supplement policy -They must be told that'll be getting all
the benefits from the Medicare Advantage plan -They
must be age 70 and above -They must have been enrolled
previously in an HMO - ANSWER//They must be told that'll
be getting all the benefits from the Medicare Advantage
plan Joyce is totally disabled. Her HMO policy just
terminated. All of the following are correct regarding
"extension of benefits" for Joyce, EXCEPT? -Coverage
ends once maximum benefits have been exhausted -
Coverage ends once another carrier assumes coverage -
Coverage ends if no longer totally disabled -Coverage
ends after 18 months - ANSWER//Coverage ends after 18
months All of the following are correct regarding Florida
regulation of HMOs, EXCEPT? -Must obtain a Certificate
of Authority -Must file a report of its activities within 3
months of the end of each fiscal year -Must deposit
$100,000 with the Rehabilitation Administration Expense
Fund -Must be sold by agents licensed and appointed as
health insurance agents - ANSWER//Must deposit
$100,000 with the Rehabilitation Administration Expense
Fund (Explanation: They must deposit $10,000 with the
Rehabilitation Administration Expense Fund.) What is
"capitation" as it relates to an HMO? -Amount to be
collected by the HMO from participating health care
providers -Fixed amount paid by an HMO during a policy
period -Fixed amount paid by an HMO to a physician for
medical services -Amount required to be deposited with
the State of Florida - ANSWER//Fixed amount paid by an
HMO to a physician for medical services When a person is
covered by an HMO, the contract certificate or member's
,handbook must be delivered within how many days after
approval of the enrollment by the HMO? -20 days -10
days -5 days -14 days - ANSWER//10 days Which of the
following statements about health service organizations is
true? -They reimburse Policyowners directly for
physicians' fees -They provide loss of income benefits to
Policyowners -They reimburse Policyowners directly for all
medical expenses -They provide benefit payments directly
to the hospitals and physicians providing services -
ANSWER//They provide benefit payments directly to the
hospitals and physicians providing services What is the
period of time for an HMO "open enrollment"? -45 days
during every 18-month period -30 days during every 12-
month period -30 days during every 18-month period -45
days during every 12-month period - ANSWER//30 days
during every 18-month period If an HMO is found guilty of
unfair trade practices, what is the maximum penalty that
can be charged? -Up to $50,000 -Up to $150,000 -Up to
$200,00 -Up to $100,000 - ANSWER//Up to $200,00
Which of the following statements about Worker's
Compensation laws is INCORRECT? -Employers can
purchase coverage through the state program, private
insurers or can self-insure -Worker's compensation
provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law -Basic
principle is that work-related injuries are compensable by
the employer without regard to fault - ANSWER//Not all
states have a workers compensation law What year was
the Social Security Act amended to add health insurance
protection for the aged and disabled? -1973 -1965 -1985 -
1935 - ANSWER//1965 All of the following are true
statements about Workers Compensation, EXCEPT..? -
Benefits are not paid unless there is employer negligence
-Pays benefits for work related injuries and illnesses -
Employee does not contribute to the plan -All states have
Workers Compensation laws - ANSWER//Benefits are not
paid unless there is employer negligence Which of the
, following is a state administered disability plan? -Social
Security -Workers Compensation -Medigap -Medicare -
ANSWER//Workers Compensation All of the following are
nontraditional methods of providing health insurance,
EXCEPT? -Multiple Employer Trusts -Multiple Employer
Welfare Arrangements -Self-insurance -Commercial
insurers - ANSWER//Commercial insurers All of the
following are true about a multiple employer welfare
arrangement (MEWA), EXCEPT? -Required by law to
have an employment-related common bond -Often provide
insurance on a self-insured basis -Tax-exempt entities -
Large employers who have joined together to provide
health insurance benefits - ANSWER//Large employers
who have joined together to provide health insurance
benefits (Explanation: MEWAs consist of small employers
who join together to provide health insurance benefits for
their employees) Grouping small businesses together to
obtain health insurance as one large group is a
characteristic of what type of group? -Multiple Employer
Trust (MET) -Franchise Health plan -Health Maintenance
Organization (HMO) -Blue Cross/Blue Shield -
ANSWER//Multiple Employer Trust (MET) Casey has a
medical expense policy that provides a fixed rate of $150
per day for hospitalization. Casey is hospitalized for 10
days and incurred covered medical expenses of $20,000.
What will her medical expense policy pay? -$1,500 -
$20,000 -$15,000 -$3,000 - ANSWER//$1,500
(Explanation: Casey's policy will only cover a fixed rate per
day for hospitalization of $150. If she is hospitalized for 10
days, then her policy will pay $1,500 ($150 x 10) of the
total $20,000 in expenses.) Jamie has a reimbursement
type medical expense policy with a maximum benefit of
$500,000. She is hospitalized and incurs $25,000 in
covered medical expenses. What will her policy provide in
coverage? -$20,000 -$25,000 -$10,000 -$12,500 -
ANSWER//$25,000 (Explanation: A reimbursement type
policy will provide coverage for expenses incurred. In this
