|ACTUAL EXAM
QUESTIONS WITH WELL DETAILED CORRECT ANSWERS|GRADED
A+|BRAND NEW 2026/2027 UPDATE
Which managed care plan has the patient receiving care from participating providers
(network provider) and the providers are only paid for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS) - ANSWER C. Exclusive Provider Organization (EPO)
EPO is a managed care plan in which enrollees must receive their care from doctors and
hospitals within the EPO network but cannot go outside of the network for care. If an
enrollee goes to a provider or hospital outside of the network the enrollee will have to pay
the medical bills out of pocket. A network provider for EPO plans is reimbursed on fee-for-
service basis.
A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage
through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance
is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for medical
care. - ANSWER A. Mother's insurance plan
Which TRICARE plan is similar to an HMO plan?
1
,A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult - ANSWER C. TRICARE Prime
TRICARE Prime is one of the three healthcare options that is similar to an HMO plan as the
patient is assigned a PCP and the treatment goes
through the PCP.
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V - ANSWER D. I, IV, V
Medicare Part A covers hospital care, skilled nursing facility care, nursing home care,
hospice, and home health services.
Which is a TRUE statement regarding Workers' Compensation?
2
, A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of the
accident.
C. Providers can balance bill a patient when compensation payment is not paid in full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWER A. There is no copayment for the injured worker in workers' compensation
cases.
There is no co-payment for workers' compensation cases. A worker (employee) cannot be
given a bill for co-pay or anything else because it is the insurance policy of the employer, and
not the workers' personal policy, that pays the bill. The filing deadline for a first report of
injury form is determined by state law. All providers must accept the compensation payment
as payment in full. There is no deductible in workers' compensation.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the charge for
the office visit. As a courtesy, the physician's staff submits a claim to Bob's insurance
company. If the service is covered by the insurance company, Bob can expect to be
reimbursed for the office visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWER C. Fee-for-service (traditional
coverage)
Blue Cross/Blue Shield fee-for-service (traditional coverage) plan is selected by individuals
who do not have the access to a group plan, and for small business employers. The plan has
two types of coverage, basic coverage and major medical benefits.
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
3
QUESTIONS WITH WELL DETAILED CORRECT ANSWERS|GRADED
A+|BRAND NEW 2026/2027 UPDATE
Which managed care plan has the patient receiving care from participating providers
(network provider) and the providers are only paid for services provided?
A. Health Maintenance Organization (HMO)
B. Point-of-Service Plan (POS)
C. Exclusive Provider Organization (EPO)
D. Integrated Delivery System (IDS) - ANSWER C. Exclusive Provider Organization (EPO)
EPO is a managed care plan in which enrollees must receive their care from doctors and
hospitals within the EPO network but cannot go outside of the network for care. If an
enrollee goes to a provider or hospital outside of the network the enrollee will have to pay
the medical bills out of pocket. A network provider for EPO plans is reimbursed on fee-for-
service basis.
A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage
through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance
is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for medical
care. - ANSWER A. Mother's insurance plan
Which TRICARE plan is similar to an HMO plan?
1
,A. TRICARE For Life
B. TRICARE Select
C. TRICARE Prime
D. TRICARE Young Adult - ANSWER C. TRICARE Prime
TRICARE Prime is one of the three healthcare options that is similar to an HMO plan as the
patient is assigned a PCP and the treatment goes
through the PCP.
Which of the services are covered by Medicare Part A?
I. Skilled Nursing Facility Care
II. Ambulatory Surgery
III. Durable Medical Equipment
IV. Hospice Care
V. Home Health Services
VI. Long Term Care
VII. Outpatient prescription drugs
A. I-VII
B. II, III, VI
C. I, II, IV, VII
D. I, IV, V - ANSWER D. I, IV, V
Medicare Part A covers hospital care, skilled nursing facility care, nursing home care,
hospice, and home health services.
Which is a TRUE statement regarding Workers' Compensation?
2
, A. There is no copayment for the injured worker in workers' compensation cases.
B. The filing deadline for a first report of injury form is one week from the date of the
accident.
C. Providers can balance bill a patient when compensation payment is not paid in full.
D. There is a deductible for the injured worker in workers' compensation claims. -
ANSWER A. There is no copayment for the injured worker in workers' compensation
cases.
There is no co-payment for workers' compensation cases. A worker (employee) cannot be
given a bill for co-pay or anything else because it is the insurance policy of the employer, and
not the workers' personal policy, that pays the bill. The filing deadline for a first report of
injury form is determined by state law. All providers must accept the compensation payment
as payment in full. There is no deductible in workers' compensation.
Bob sees his family physician for seasonal allergies. Before leaving, Bob pays the charge for
the office visit. As a courtesy, the physician's staff submits a claim to Bob's insurance
company. If the service is covered by the insurance company, Bob can expect to be
reimbursed for the office visit. This is which type of insurance model?
A. Healthcare Anywhere
B. Managed Care Plan
C. Fee-for-service (traditional coverage)
D. Health Maintenance Organization (HMO) - ANSWER C. Fee-for-service (traditional
coverage)
Blue Cross/Blue Shield fee-for-service (traditional coverage) plan is selected by individuals
who do not have the access to a group plan, and for small business employers. The plan has
two types of coverage, basic coverage and major medical benefits.
Which of the following benefits are NOT covered by all Medigap policies?
I. Part A co-insurance and hospital costs
II. Skilled nursing facility care co-insurance
3
