FREE ExamFX Health Insurance Questions and Answers
What does a Health Maintenance Organization (HMO) require from its members?
HMOs typically require members to use in-network healthcare providers to manage costs. Exceptions may apply for emergency care, but generally, members must also obtain referrals from a primary care physician (PCP) to see specialists.
What is the purpose of coinsurance in a health insurance policy?
Coinsurance is a cost-sharing arrangement where the insured pays a percentage of the covered expenses after meeting the deductible, while the insurer pays the remaining percentage. For example, with an 80/20 plan, the insurer covers 80%, and the insured covers 20%.
Which government program primarily provides health insurance for individuals aged 65 and older?
Medicare is a federal health insurance program designed for individuals aged 65 and older, as well as certain younger people with disabilities or specific medical conditions. Medicaid, on the other hand, is for low-income individuals and families.
What is a pre-existing condition in the context of health insurance?
A pre-existing condition is any medical condition diagnosed or treated before the health insurance policy started. The Affordable Care Act prohibits insurers from denying coverage or charging higher premiums due to pre-existing conditions.
What is the primary function of a health insurance deductible?
A deductible is the amount the insured must pay out of pocket for healthcare services before the insurance plan starts covering expenses. For example, if the deductible is $1,000, the insured must pay this amount before the plan begins paying benefits, except for preventive care in most cases.