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AHIP Final Exam Practice Test & Study Guide 2025-2026 – 120 Verified
Questions with Answers | 100% Graded
1. What is the primary purpose of the Affordable Care Act (ACA)?
A. To expand health insurance coverage and reduce costs.
B. To eliminate Medicare.
C. To increase insurance premiums.
D. To privatize Medicaid.
Correct Answer: A. To expand health insurance coverage and reduce costs.
Rationale: The ACA aims to increase access to affordable health insurance,
improve quality, and reduce healthcare costs.
2. Which of the following is a requirement for health insurance marketplaces under
the ACA?
A. Must provide plans with essential health benefits.
B. Must cover only catastrophic plans.
C. Can exclude coverage for pre-existing conditions.
D. Does not have to offer subsidies.
Correct Answer: A. Must provide plans with essential health benefits.
Rationale: Marketplaces are required to offer insurance plans covering ten
essential health benefits to ensure comprehensive coverage.
3. What is the function of a Health Savings Account (HSA)?
A. To allow individuals to save pre-tax money for qualified medical expenses.
B. To pay premiums for employer insurance.
, 2
C. To cover cosmetic procedures only.
D. To reimburse Medicare copays.
Correct Answer: A. To allow individuals to save pre-tax money for qualified
medical expenses.
Rationale: HSAs provide tax advantages for saving money for healthcare
expenses, often paired with high-deductible health plans.
4. Under Medicare, what does Part B typically cover?
A. Outpatient services such as doctor visits and preventive care.
B. Hospital stays.
C. Prescription drugs.
D. Long-term nursing home care.
Correct Answer: A. Outpatient services such as doctor visits and preventive care.
Rationale: Medicare Part B covers outpatient medical services and preventive
care, distinct from hospital coverage under Part A.
5. What is the maximum out-of-pocket limit for ACA marketplace plans in 2025?
A. It varies annually; for 2025, it is approximately $9,100.
B. $15,000 fixed by law.
C. There is no limit.
D. $3,000 maximum.
Correct Answer: A. It varies annually; for 2025, it is approximately $9,100.
Rationale: The ACA sets annual out-of-pocket maximums, which are adjusted
yearly for inflation.
6. What role does a “navigator” play in the health insurance marketplace?
A. Assists consumers in understanding and enrolling in health plans.
B. Sells insurance policies for profit.
C. Sets insurance premium prices.
D. Denies coverage applications.
, 3
Correct Answer: A. Assists consumers in understanding and enrolling in health
plans.
Rationale: Navigators are trained to guide consumers through marketplace options
without selling insurance or receiving commissions.
7. Which of the following qualifies as a “life event” that allows special enrollment
outside the ACA open enrollment period?
A. Marriage, birth of a child, loss of other coverage.
B. Change in employment.
C. Moving to a different state.
D. All of the above.
Correct Answer: D. All of the above.
Rationale: Certain qualifying life events permit individuals to enroll or change
coverage outside regular enrollment periods.
8. What is the “individual mandate” penalty status as of 2025?
A. There is no federal penalty for not having health insurance.
B. A $695 annual penalty applies.
C. Penalties are only for Medicare beneficiaries.
D. Penalties are collected by insurance companies.
Correct Answer: A. There is no federal penalty for not having health insurance.
Rationale: The ACA’s federal individual mandate penalty was reduced to $0
starting in 2019.
9. What does Medicaid expansion under the ACA provide?
A. Extends Medicaid eligibility to individuals with incomes up to 138% of the
federal poverty level.
B. Limits Medicaid to children only.
C. Eliminates state Medicaid programs.
D. Increases Medicaid premiums.
, 4
Correct Answer: A. Extends Medicaid eligibility to individuals with incomes up
to 138% of the federal poverty level.
Rationale: Medicaid expansion allows more low-income adults to qualify for
coverage in participating states.
10. What is “cost-sharing reduction” in ACA marketplace plans?
A. A subsidy that lowers out-of-pocket costs for eligible low-income individuals.
B. An increase in premiums.
C. A type of tax penalty.
D. Coverage exclusion for pre-existing conditions.
Correct Answer: A. A subsidy that lowers out-of-pocket costs for eligible low-
income individuals.
Rationale: Cost-sharing reductions reduce deductibles and copayments for
qualifying enrollees.
11. What is a “premium” in health insurance terms?
A. The monthly payment to maintain health insurance coverage.
B. The amount paid at the time of service.
C. The maximum amount paid annually.
D. The discount on medications.
Correct Answer: A. The monthly payment to maintain health insurance coverage.
Rationale: Premiums are recurring payments to keep a health insurance policy
active.
12. Which of the following is NOT covered under Medicare Part D?
A. Over-the-counter medications.
B. Prescription drugs.
C. Vaccinations.
D. Insulin.
AHIP Final Exam Practice Test & Study Guide 2025-2026 – 120 Verified
Questions with Answers | 100% Graded
1. What is the primary purpose of the Affordable Care Act (ACA)?
A. To expand health insurance coverage and reduce costs.
B. To eliminate Medicare.
C. To increase insurance premiums.
D. To privatize Medicaid.
Correct Answer: A. To expand health insurance coverage and reduce costs.
Rationale: The ACA aims to increase access to affordable health insurance,
improve quality, and reduce healthcare costs.
2. Which of the following is a requirement for health insurance marketplaces under
the ACA?
A. Must provide plans with essential health benefits.
B. Must cover only catastrophic plans.
C. Can exclude coverage for pre-existing conditions.
D. Does not have to offer subsidies.
Correct Answer: A. Must provide plans with essential health benefits.
Rationale: Marketplaces are required to offer insurance plans covering ten
essential health benefits to ensure comprehensive coverage.
3. What is the function of a Health Savings Account (HSA)?
A. To allow individuals to save pre-tax money for qualified medical expenses.
B. To pay premiums for employer insurance.
, 2
C. To cover cosmetic procedures only.
D. To reimburse Medicare copays.
Correct Answer: A. To allow individuals to save pre-tax money for qualified
medical expenses.
Rationale: HSAs provide tax advantages for saving money for healthcare
expenses, often paired with high-deductible health plans.
4. Under Medicare, what does Part B typically cover?
A. Outpatient services such as doctor visits and preventive care.
B. Hospital stays.
C. Prescription drugs.
D. Long-term nursing home care.
Correct Answer: A. Outpatient services such as doctor visits and preventive care.
Rationale: Medicare Part B covers outpatient medical services and preventive
care, distinct from hospital coverage under Part A.
5. What is the maximum out-of-pocket limit for ACA marketplace plans in 2025?
A. It varies annually; for 2025, it is approximately $9,100.
B. $15,000 fixed by law.
C. There is no limit.
D. $3,000 maximum.
Correct Answer: A. It varies annually; for 2025, it is approximately $9,100.
Rationale: The ACA sets annual out-of-pocket maximums, which are adjusted
yearly for inflation.
6. What role does a “navigator” play in the health insurance marketplace?
A. Assists consumers in understanding and enrolling in health plans.
B. Sells insurance policies for profit.
C. Sets insurance premium prices.
D. Denies coverage applications.
, 3
Correct Answer: A. Assists consumers in understanding and enrolling in health
plans.
Rationale: Navigators are trained to guide consumers through marketplace options
without selling insurance or receiving commissions.
7. Which of the following qualifies as a “life event” that allows special enrollment
outside the ACA open enrollment period?
A. Marriage, birth of a child, loss of other coverage.
B. Change in employment.
C. Moving to a different state.
D. All of the above.
Correct Answer: D. All of the above.
Rationale: Certain qualifying life events permit individuals to enroll or change
coverage outside regular enrollment periods.
8. What is the “individual mandate” penalty status as of 2025?
A. There is no federal penalty for not having health insurance.
B. A $695 annual penalty applies.
C. Penalties are only for Medicare beneficiaries.
D. Penalties are collected by insurance companies.
Correct Answer: A. There is no federal penalty for not having health insurance.
Rationale: The ACA’s federal individual mandate penalty was reduced to $0
starting in 2019.
9. What does Medicaid expansion under the ACA provide?
A. Extends Medicaid eligibility to individuals with incomes up to 138% of the
federal poverty level.
B. Limits Medicaid to children only.
C. Eliminates state Medicaid programs.
D. Increases Medicaid premiums.
, 4
Correct Answer: A. Extends Medicaid eligibility to individuals with incomes up
to 138% of the federal poverty level.
Rationale: Medicaid expansion allows more low-income adults to qualify for
coverage in participating states.
10. What is “cost-sharing reduction” in ACA marketplace plans?
A. A subsidy that lowers out-of-pocket costs for eligible low-income individuals.
B. An increase in premiums.
C. A type of tax penalty.
D. Coverage exclusion for pre-existing conditions.
Correct Answer: A. A subsidy that lowers out-of-pocket costs for eligible low-
income individuals.
Rationale: Cost-sharing reductions reduce deductibles and copayments for
qualifying enrollees.
11. What is a “premium” in health insurance terms?
A. The monthly payment to maintain health insurance coverage.
B. The amount paid at the time of service.
C. The maximum amount paid annually.
D. The discount on medications.
Correct Answer: A. The monthly payment to maintain health insurance coverage.
Rationale: Premiums are recurring payments to keep a health insurance policy
active.
12. Which of the following is NOT covered under Medicare Part D?
A. Over-the-counter medications.
B. Prescription drugs.
C. Vaccinations.
D. Insulin.
