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  4. Medical Plans

Free Medical Plans Practice Questions

Massachusetts Accident & Health exam — 42 practice questions.

Subtopics: HMO, PPO, Deductible, Coinsurance, Copayment, Out-of-pocket maximum, Fee-for-service, Stop-loss, Major medical, POS, Gatekeeper, Preauthorization, Utilization review, Preventive care, Coordination of benefits, Comprehensive major medical, HIPAA portability, HIPAA privacy, Dependent to age 26, Exclusive Provider Organization, High-deductible health plan, Capitation, Closed-panel HMO, Open-panel HMO, Concurrent review, Second surgical opinion, Case management, Out-of-network cost sharing, Essential health benefits, Metal tier levels, Guaranteed issue, Medical loss ratio, Annual and lifetime limit prohibition, Health insurance marketplace, Premium tax credit, Prescription drug formulary, Major medical cost-sharing

Read the Medical Plans study guide

Sample questions & answers

1. A health maintenance organization (HMO) typically requires members to:

Receive care through a network and often a primary care physician

HMOs deliver care through a defined network and often coordinate services through a primary care physician.

2. A preferred provider organization (PPO) generally allows members to:

Use out-of-network providers at a higher cost

PPOs let members use out-of-network providers, though usually at higher out-of-pocket cost than in-network care.

3. The amount an insured must pay for covered services before the health plan begins to pay is the:

Deductible

A deductible is the amount the insured pays out of pocket before the plan starts paying covered expenses.

4. Coinsurance in a medical plan refers to:

The percentage of covered costs the insured shares after the deductible

Coinsurance is the percentage of covered expenses shared by the insured after the deductible is met.

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Practice: Medical Plans

Take a randomized, timed-style practice test. Answer choices are shuffled and your results are scored instantly with an explanation for every question.

Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Pennsylvania Insurance Department and the exam administrator before relying on it.