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Massachusetts Health Practice Exam

20 exam-style questions drawn from the same bank as our full Massachusetts Health course (Massachusetts Accident, Health or Sickness Producer Exam Prep). Answer all 20, then grade yourself — most state exams require 70% to pass. Explanations for every question are part of the full course.

1. Forty-eight months before applying for Medicaid long-term care coverage of nursing-facility services, an applicant gifted $120,000 to her adult daughter. The state's average monthly nursing-facility cost is $10,000 per month. Assuming no gift qualifies for any §1917 transfer exemption, the applicant will:
Face no transfer-of-assets penalty because the gift occurred more than 36 months before applicationBe permanently disqualified from Medicaid because of the giftReceive Medicaid coverage retroactively but must reimburse the state for the $120,000Face a 12-month transfer-of-assets penalty period because the gift was made within the 60-month look-back
2. A Massachusetts long-term care policy may NOT exclude:
Alzheimer's diseaseintentional self-inflicted injurywar or an act of warservices under workers' compensation
3. A §7702B(e) acceleration rider on a life/LTC combination policy differs from an extension-of-benefits rider in that:
The §7702B(e) acceleration rider may be funded only by a single up-front premium at issue; the extension rider may be funded by recurring annual premium over the life of the underlying chassis under the standard NAIC funding rulesThe extension-of-benefits rider eliminates the requirement that the underlying life chassis satisfy §7702B because the additional LTC pool stands alone as a separately-qualified contract under the federal hybrid-product frameworkOnly the §7702B(e) acceleration rider produces federal tax-free LTC benefits under IRC §7702B(b); the extension-of-benefits rider is treated as a separate non-qualified arrangement and its LTC payouts are taxable as ordinary incomeThe acceleration rider pays LTC benefits by drawing down the life policy's death benefit; the extension rider provides an additional LTC-only pool of money that activates after the death benefit is exhausted
4. Under standard coordination-of-benefits rules, what is the ceiling on what a secondary major-medical plan will pay on a claim the primary plan has already partly paid?
Half the balance remaining after the primary plan has finished adjudicatingThe full allowed amount, because secondary coverage restores the member fullyWhatever the provider bills above the primary plan's contracted allowed amountThe amount it would have paid as primary, less what the primary plan paid
5. An HR manager enrolls new hires in the employer group health plan and takes no payment from the carrier. She is:
exempt from licensing under s. 162Jrequired to hold a temporary licencerequired to hold a producer licenceexempt only if the group has 50 lives
6. The principal difference between a gold-tier and a silver-tier qualified health plan on the Marketplace is that:
The gold plan has an actuarial value of approximately 80% (plan pays 80%, member 20%); the silver plan has an AV of approximately 70%Only the silver-tier plan is eligible for advance premium tax credits under the SLCSP-benchmark calculation used in the federal subsidy frameworkOnly the gold-tier plan is statutorily required to cover the ten ACA Essential Health Benefits categories under federal market reformsThe gold plan is available only through state-based marketplaces under the SBM-only exemption; the silver plan is available on every state and federal exchange platform
7. The ethics component within the 45 hours is equivalent to:
6 classroom hours2 classroom hours4 classroom hours3 classroom hours
8. What distinguishes a residual disability benefit from a partial disability benefit?
It requires prior total disability firstIt pays only for the first six monthsIt pays in proportion to lost incomeIt pays a flat half of the total benefit
9. The mandate penalty is reported and collected through:
the employer payroll systema Division of Insurance assessmentthe state income tax returna Connector monthly invoice
10. Under 211 CMR 65.06, inflation protection and a nonforfeiture benefit must be:
approved by the Commissioner firstoffered, and may be rejectedincluded in every policypriced separately at renewal
11. Under c. 118E, s. 9A, former foster care youth are covered up to age:
21263023
12. M.G.L. c. 175, s. 162R states which civil penalty amount?
$5,000 for a willful violation$10,000 for a repeated violationnone, it refers to c. 176D, s. 7$1,000 for each violation
13. Under the ACA's medical loss ratio (MLR) rules, an insurer in the LARGE group market must spend at least what percentage of premium on claims and quality improvement activities to avoid issuing rebates to policyholders?
85%80%70%75%
14. A legacy individual policy contains a fourth-quarter carryover provision. What does that provision do for the insured?
It suspends coinsurance during the last three months of every policy yearIt refunds a quarter of the deductible if no claim is filed during the yearIt moves the plan-year reset date to the first day of the fourth quarterIt lets expenses from the final three months also count toward next year
15. A plan lets the insured use any licensed provider, imposes no primary care gatekeeper, and reimburses each service subject to usual-customary-and-reasonable limits. That plan is best classified as:
An exclusive provider organization plan with no primary care referral ruleA preferred provider organization plan with an unusually broad provider panelA fee-for-service indemnity plan, the model managed care is defined againstA point-of-service plan being used in its out-of-network mode by the insured
16. The advance premium tax credit available to a Marketplace enrollee is calculated based on the cost of the:
Lowest-cost bronze plan available in the enrollee's rating area under the Marketplace-published rate filings for the coming plan yearSecond-lowest-cost silver plan (SLCSP) available in the enrollee's rating area, regardless of which plan the enrollee actually selectsAverage weighted premium across all metal tiers offered to the enrollee in the rating area, computed under the federal benchmark-blending formulaPlan the enrollee actually selects at enrollment, regardless of metal tier or whether the chosen plan is bronze, silver, gold, or platinum
17. A critical illness insurance policy pays benefits in the form of:
Reimbursement to the hospital for medical expenses related to the covered conditionA lump sum paid to the insured upon first diagnosis of a covered condition, regardless of the insured's actual medical expensesA monthly disability income benefit replacing lost wages while the insured is unable to workCoordination-of-benefits payments that fill the gap between the major medical plan and the hospital's billed charges
18. Under IRC §223, the additional 'catch-up' HSA contribution permitted for an account holder who is age 55 or older by year-end is:
$1,000 per year$2,500 per yearEqual to the regular self-only contribution limit$500 per year
19. Under M.G.L. c. 175, s. 108E, an insured refuses consent to disclose outpatient mental health information. The insurer may:
require consent as a claim conditiondeny the claim for non-cooperationnot deny benefits for the refusaldeny only the mental health portion
20. An insured's coverage terminated on June 30. In August she receives treatment for a chronic condition that first arose in March, while the policy was still in force. The claim is:
Payable, because the condition itself arose during the policy period in MarchPayable, because chronic conditions are treated as continuing covered claimsNot payable, because the care was rendered after the policy period endedNot payable, because a chronic condition is a categorical contract exclusion

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