AHIP MCQ 3 — Questions and Answers
Question 1: What is the primary purpose of a Health Savings Account (HSA)?
- To pay insurance premiums pre-tax
- To save pre-tax dollars for qualified medical expenses paired with an HDHP (Correct answer)
- To reimburse employees for any health-related expense
- To fund long-term care insurance premiums only
Correct answer: To save pre-tax dollars for qualified medical expenses paired with an HDHP
HSAs allow individuals with HDHPs to contribute pre-tax funds for qualified medical expenses, with a triple tax advantage.
Question 2: Which of the following best describes the difference between coinsurance and a copayment?
- Coinsurance is a flat dollar amount; copayment is a percentage of the claim
- Coinsurance is a percentage of the claim cost; copayment is a flat dollar amount (Correct answer)
- Both are percentages but apply to different claim types
- Copayments apply only to outpatient services; coinsurance applies only to hospital stays
Correct answer: Coinsurance is a percentage of the claim cost; copayment is a flat dollar amount
Coinsurance is the member's percentage share of a covered service cost, while a copayment is a fixed dollar amount per visit or service.
Question 3: A Medicare beneficiary who disenrolls from a Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP) can do which of the following?
- Enroll in any Part D plan
- Enroll in a different MA plan or return to Original Medicare with or without a standalone Part D plan (Correct answer)
- Only return to Original Medicare without Part D
- Enroll in a Medigap plan without medical underwriting
Correct answer: Enroll in a different MA plan or return to Original Medicare with or without a standalone Part D plan
During the MA OEP (January 1–March 31), beneficiaries can switch to another MA plan or drop MA and return to Original Medicare, and may add a PDP.
Question 4: Under the Affordable Care Act, which metal tier plan has the highest actuarial value?
- Bronze
- Silver
- Gold
- Platinum (Correct answer)
Correct answer: Platinum
Platinum plans have an actuarial value of approximately 90%, meaning the plan pays 90% of covered expenses on average.
Question 5: Which of the following is a key difference between Medicare Supplement (Medigap) and Medicare Advantage plans?
- Medigap plans replace Original Medicare; Medicare Advantage supplements it
- Medigap plans are sold by the government; Medicare Advantage is sold by private insurers
- Medigap plans work alongside Original Medicare; Medicare Advantage replaces it (Correct answer)
- Both plan types require referrals to see specialists
Correct answer: Medigap plans work alongside Original Medicare; Medicare Advantage replaces it
Medigap plans supplement Original Medicare by covering cost-sharing gaps, while Medicare Advantage replaces Original Medicare with a private plan.
Question 6: When calculating an ACA marketplace subsidy (Premium Tax Credit), which income benchmark is used?
- Gross income
- Adjusted Gross Income (AGI)
- Modified Adjusted Gross Income (MAGI) (Correct answer)
- Net income after all deductions
Correct answer: Modified Adjusted Gross Income (MAGI)
The Premium Tax Credit is based on MAGI, which includes AGI plus certain non-taxable income such as Social Security benefits.
Question 7: Which federal law prohibits group health plans from imposing pre-existing condition exclusions on enrollees who have maintained creditable coverage with no break of more than 63 days?
- COBRA
- ERISA
- HIPAA (Correct answer)
- ACA
Correct answer: HIPAA
HIPAA's portability provisions restrict pre-existing condition exclusion periods based on prior creditable coverage before the ACA eliminated them for most plans.
AHIP MCQ 3
What is the primary purpose of a Health Savings Account (HSA)?