Kentucky Health Insurance Practice Exam Free - 2026

• A. 9 months
• B. 12 months
• C. 18 months after the date group coverage would otherwise have terminated
• D. 36 months after the date group coverage would otherwise have terminated

Correct answer: C. 18 months after the date group coverage would otherwise have terminated

Explanation: KRS 304.18-110(3)(a) provides that continued group health coverage terminates on the earlier of eighteen (18) months after the date group coverage would otherwise have ended, failure to pay premium, or termination of the group policy without replacement within 31 days. Eligibility requires at least three months of prior group coverage and election with payment within 31 days after the insurer's notice (subsections (2) and (7)). Nine, 12, and 36 months are not Kentucky's continuation period. See KRS 304.18-110.

• A. She must request external review within 180 days and pay a $50 fee to the insurer
• B. She may request review only if the treatment costs at least $500 and must file within 30 days
• C. External review is available only after she files a lawsuit
• D. She must submit the request to the insurer within 60 days of the adverse determination notice and is assessed a one-time $25 filing fee payable to the independent review entity (waivable)

Correct answer: D. She must submit the request to the insurer within 60 days of the adverse determination notice and is assessed a one-time $25 filing fee payable to the independent review entity (waivable)

Explanation: KRS 304.17A-623 requires an external review of an adverse determination where the internal appeal is complete (or waived or untimely), the person was enrolled, and the course of treatment would cost at least one hundred dollars ($100) without insurance; the request must be submitted to the insurer within sixty (60) days of receiving notice of the adverse determination from the internal appeal, and the covered person is assessed a one-time filing fee of twenty-five dollars ($25) paid to the independent review entity, which may be waived. The 180-day/$50, $500/30-day, and lawsuit-first descriptions are all incorrect. See KRS 304.17A-621; KRS 304.17A-623.

• A. 30 calendar days (60 days for organ transplant claims)
• B. 15 calendar days
• C. 45 calendar days
• D. 90 calendar days

Correct answer: A. 30 calendar days (60 days for organ transplant claims)

Explanation: KRS 304.17A-702(1) requires each insurer to reimburse a provider for a clean claim, or send written or electronic notice denying or contesting it, within thirty (30) calendar days of receipt; clean claims involving organ transplants must be paid, denied, or contested within sixty (60) calendar days. Fifteen days is the acknowledgment period in the P&C claims regulation, and 45 and 90 days are not the health prompt-pay time frames. See KRS 304.17A-702.

• A. 10 days
• B. 30 days
• C. 60 days
• D. 90 days

Correct answer: B. 30 days

Explanation: KRS 304.9-200(2) requires a licensee to inform the commissioner in writing, in a format acceptable to the commissioner, of a change of address or change of legal name within thirty (30) days of the change. Ten, 60, and 90 days are not the statutory period. See KRS 304.9-200.

• A. The portion of the Medicare-approved amount that remains after Part B pays its 80 percent share
• B. The amount a beneficiary pays above the standard Part B premium because of higher income
• C. The surcharge added to the Part B premium for each year the beneficiary delayed enrollment
• D. The amount a nonparticipating provider may bill above the Medicare-approved amount

Correct answer: D. The amount a nonparticipating provider may bill above the Medicare-approved amount

Explanation: An excess charge arises when a provider who does not accept Medicare assignment bills more than the Medicare-approved amount, leaving the beneficiary responsible for the difference within legal limits. The Part B coinsurance, the income-related premium adjustment, and the late enrollment penalty are separate cost items unrelated to a provider's billing behavior, and no Medigap plan covers premium surcharges.

• A. They pay a stated percentage of certain cost-sharing items and include an annual out-of-pocket limit, after which they pay covered costs in full for the rest of the year
• B. They pay all Medicare cost-sharing items in full but impose an annual benefit maximum, after which the beneficiary must pay all covered costs personally for the rest of the calendar year
• C. They are high deductible versions of Plans F and G, paying nothing until the beneficiary has met a deductible that is set each year by Medicare
• D. They are Medicare SELECT plans that pay full benefits only when the beneficiary uses network hospitals and providers selected by the insurer

Correct answer: A. They pay a stated percentage of certain cost-sharing items and include an annual out-of-pocket limit, after which they pay covered costs in full for the rest of the year

Explanation: Plans K and L trade lower premiums for partial payment of specified cost-sharing items such as the Part A deductible, skilled nursing facility coinsurance, Part B coinsurance, blood, and hospice coinsurance, balanced by an annual out-of-pocket maximum after which the plan pays covered costs in full for the remainder of the calendar year. The Part A hospital coinsurance and the 365 additional lifetime hospital days are still paid in full, and the plans carry an out-of-pocket limit rather than a benefit maximum. High deductible Plans F and G and Medicare SELECT are separate, distinct Medigap structures.

• A. It is mandatory outpatient prescription drug coverage administered directly by Medicare, and a beneficiary is enrolled automatically upon becoming entitled to Part A
• B. It is voluntary outpatient prescription drug coverage offered through private plans, and a beneficiary who delays enrollment without creditable drug coverage may owe a permanent late enrollment penalty
• C. It is voluntary outpatient prescription drug coverage offered through private plans, and a beneficiary who delays enrollment without creditable drug coverage pays a temporary penalty that ends after twelve months
• D. It is prescription drug coverage that is built into every standardized Medicare Supplement plan letter, with the premium deducted from the beneficiary's Social Security benefits

Correct answer: B. It is voluntary outpatient prescription drug coverage offered through private plans, and a beneficiary who delays enrollment without creditable drug coverage may owe a permanent late enrollment penalty

Explanation: Part D is optional and delivered by private stand-alone drug plans or by Medicare Advantage plans that include drug coverage, with a lasting premium penalty designed to discourage waiting until drugs are needed. Enrollment is not automatic with Part A, the late enrollment penalty lasts for as long as the beneficiary has Part D coverage rather than ending after a year, and Medigap policies sold since Part D began may not include drug coverage.

• A. Confirm that every Medigap plan letter pays custodial care in an assisted living facility once the beneficiary has satisfied a 100-day waiting period
• B. Explain that Plan G covers assisted living in full, but only after Medicare's skilled nursing facility benefit has been exhausted for the benefit period
• C. Explain that Medigap fills gaps in Original Medicare and therefore does not pay for custodial long-term care, which requires a separate long-term care policy
• D. Recommend adding a second Medigap policy with a different plan letter so the two policies together will cover the assisted living costs

Correct answer: C. Explain that Medigap fills gaps in Original Medicare and therefore does not pay for custodial long-term care, which requires a separate long-term care policy

Explanation: Medigap benefits are derivative: they can only supplement what Medicare itself covers, and Medicare does not pay for ongoing custodial care, so no plan letter fills that need. Plan G is a comprehensive supplement but is still bound by that limit. There is no custodial care waiting period that unlocks the benefit, and buying a second Medigap policy would be prohibited duplication.

• A. Collecting a full year of premium in advance so the rate is locked in permanently, and explaining that the free look period is waived once the first premium payment has been accepted by the issuing insurer
• B. Describing the policy as endorsed by Medicare to build confidence, and documenting that the applicant understands the policy will replace rather than duplicate Original Medicare benefits
• C. Comparing plans only on premium, since standardized benefits make everything else irrelevant, and relying on the applicant's verbal assurance that no other Medigap coverage is in force
• D. Determining and documenting whether the applicant already has coverage that would duplicate the policy, and honoring the required free look period during which the policy may be returned for a full premium refund

Correct answer: D. Determining and documenting whether the applicant already has coverage that would duplicate the policy, and honoring the required free look period during which the policy may be returned for a full premium refund

Explanation: Suitability rules require a producer to ask about and record existing coverage to avoid duplication, and Medigap policies carry a free look, commonly 30 days, letting the buyer return the policy for a full refund. Implying government endorsement is a misrepresentation, since Medigap is private insurance. Prepaying premium does not freeze rates, and responsible comparison also considers the insurer's rating method, rate history, and service.

• A. Deductible only as part of itemized medical expenses, and only to the extent total qualifying medical costs exceed the applicable percentage of adjusted gross income
• B. Fully deductible from gross income regardless of the taxpayer's other circumstances
• C. Never deductible under any circumstances
• D. Deductible only if the policy also includes disability income coverage

Correct answer: A. Deductible only as part of itemized medical expenses, and only to the extent total qualifying medical costs exceed the applicable percentage of adjusted gross income

Explanation: An individual buyer generally gets no above-the-line deduction and must itemize, clearing an AGI floor before any benefit appears, which means most taxpayers deduct nothing. A blanket full deduction is available in narrower situations such as the self-employed health insurance deduction, not to individuals generally. Bundling disability coverage does not create deductibility, and saying it is never deductible ignores the itemized route.

• A. Fully taxable as ordinary income
• B. Received free of federal income tax
• C. Taxable only to the extent they exceed her prior salary
• D. Taxable at capital gains rates

Correct answer: B. Received free of federal income tax

Explanation: The controlling rule is who paid with what dollars: because the premiums were not deducted, the benefits come back tax free. Full taxation applies where an employer paid the premium and took a deduction. Disability benefits are ordinary in character, not capital gains, and there is no rule taxing only the portion above prior salary.

• A. Tax free to the employee because group coverage is always exempt
• B. Tax free up to the elimination period, then taxable
• C. Taxable income to the employee
• D. Tax free to the employee but taxable to the employer

Correct answer: C. Taxable income to the employee

Explanation: When the employer deducts the premium and the employee is not taxed on it, the benefits become taxable income to the employee, keeping the dollars taxed exactly once. Group status by itself does not create exemption; the premium source does. The employer has no benefit income to report, and elimination periods affect when benefits begin, not how they are taxed.