FREE CHAA Payer Types and Coordination of Benefits (COB) Questions and Answers

Question 1

A 67-year-old patient has Medicare and is also covered by an Employer Group Health Plan (EGHP) from their current, active employment. The employer has 50 employees. Which plan is primary?

Accepted Answer

The Employer Group Health Plan (EGHP)

Answer

Medicare

Answer

The plans pay 50/50

Answer

Medicaid

Question 2

A child is covered by insurance plans from both parents. The mother's birthday is April 10, 1985, and the father's birthday is February 25, 1983. According to the standard 'birthday rule', which parent's plan is primary?

Accepted Answer

The father's plan

Answer

The mother's plan

Answer

The plan of the parent who is older

Answer

The plan that has been in effect longer

Question 3

Which of the following best describes a key feature of a Health Maintenance Organization (HMO) plan?

Accepted Answer

It requires a referral from a Primary Care Physician (PCP) to see a specialist.

Answer

It allows members to see any doctor without a referral at the same cost.

Answer

It is a government-funded plan for military personnel.

Answer

It functions as a savings account for medical expenses.

Question 4

What is the primary purpose of Coordination of Benefits (COB)?

Accepted Answer

To determine the primary and secondary payer to prevent overpayment

Answer

To allow patients to choose which of their plans will pay for a service

Answer

To verify the patient's home address and phone number

Answer

To combine the deductibles of two plans into one smaller deductible

Question 5

For a patient who is dually eligible for both Medicare and Medicaid, which plan is considered the 'payer of last resort'?

Accepted Answer

Medicaid

Answer

Medicare

Answer

A commercial supplement plan

Answer

The patient is responsible first

Question 6

A major advantage for a patient with a Preferred Provider Organization (PPO) plan compared to an HMO is:

Accepted Answer

They have the flexibility to see out-of-network providers.

Answer

They have no annual deductible.

Answer

All services are covered at 100% with no copay.

Answer

They are only available to government employees.

A 67-year-old patient has Medicare and is also covered by an Employer Group Health Plan (EGHP) from their current, active employment.The employer has 50 employees.Which plan is primary?

A 67-year-old patient has Medicare and is also covered by an Employer Group Health Plan (EGHP) from their current, active employment.
The employer has 50 employees.
Which plan is primary?