Texas Health Insurance Practice Exam Free - 2026

• A. 19
• B. 21
• C. 25
• D. 26

Correct answer: D. 26

Explanation: The definition of dependent in Chapter 1551 includes the spouse and an unmarried child younger than 26 years of age. A child of any age who is mentally or physically incapacitated and dependent on the member for care is also a dependent, and the term child includes natural, adopted, step and foster children. See Tex. Ins. Code 1551.004.

• A. One
• B. Two
• C. Three
• D. Five

Correct answer: C. Three

Explanation: Texas limits required chemical dependency coverage to a lifetime maximum of three separate treatment series for each covered individual. A treatment series is a planned, structured program to promote chemical-free status, which ends when the person is discharged on medical advice or fails to comply with treatment for 30 days. The coverage itself must be no less favorable than coverage for physical illness generally. See Tex. Ins. Code 1368.006, 1368.005.

• A. Six months
• B. Nine months
• C. Twelve months
• D. Twenty-four months

Correct answer: A. Six months

Explanation: Texas Medicare supplement standards provide that a policy or certificate must not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because they involved a preexisting condition. Longer look-back or exclusion periods are not permitted for Medigap in Texas. See 28 TAC 3.3306.

• A. Deterioration of the insured's health
• B. Nonpayment of premium or material misrepresentation only
• C. The insured's claims exceeding a set dollar amount
• D. Any reason with 30 days' written notice

Correct answer: B. Nonpayment of premium or material misrepresentation only

Explanation: Every Texas Medicare supplement policy must be guaranteed renewable. The issuer may not cancel or nonrenew it solely on the ground of the individual's health status or deterioration of health, and may only cancel for nonpayment of premium or material misrepresentation. See 28 TAC 3.3306.

• A. 10% of his plan's premium for each year of delay, for as long as he keeps Part B
• B. A flat annual surcharge set by his plan
• C. There is no penalty as long as he eventually enrolls
• D. 1% of the national base beneficiary premium for each month without coverage, added to his premium for as long as he has Medicare drug coverage

Correct answer: D. 1% of the national base beneficiary premium for each month without coverage, added to his premium for as long as he has Medicare drug coverage

Explanation: The Part D penalty is 1% of the national base beneficiary premium for each full month the person went without Part D or other creditable drug coverage, so 20 months of delay adds about 20%. The penalty is recalculated from the national base premium each year and continues for as long as the person has Medicare drug coverage. See medicare.gov.

• A. It must sell her the policy and cannot use her answers to medical questions to deny coverage or change the price
• B. It must sell her the policy but may triple the premium based on her health
• C. It may decline her but must refund her application fee
• D. It must give her a free policy for one year

Correct answer: A. It must sell her the policy and cannot use her answers to medical questions to deny coverage or change the price

Explanation: Guaranteed issue rights, also called Medigap protections, arise in situations such as losing other coverage through no fault of your own. When one applies, the insurer cannot deny the Medigap policy, cannot use medical underwriting to raise the price, and generally cannot impose waiting periods beyond limited pre-existing condition rules. See medicare.gov.

• A. Nothing; Medigap policies must always be issued on request
• B. It may only adjust the deductible, not the premium
• C. It may use medical underwriting to charge more or decline the application
• D. It must issue the policy but may exclude all claims permanently

Correct answer: C. It may use medical underwriting to charge more or decline the application

Explanation: Outside the Medigap open enrollment period, and without a guaranteed issue right, insurers are not required to sell a Medigap policy: they may apply medical underwriting, charge a higher premium based on health, or refuse the application altogether. This is why timing a Medigap purchase matters. See medicare.gov.

• A. The Medigap open enrollment period repeats every fall
• B. The Medigap open enrollment period is a one-time 6-month window that begins the first month the person has Part B and is 65 or older, and it does not repeat annually
• C. The Medigap period lasts 7 months and recurs each birthday
• D. There is no separate Medigap enrollment period

Correct answer: B. The Medigap open enrollment period is a one-time 6-month window that begins the first month the person has Part B and is 65 or older, and it does not repeat annually

Explanation: Medigap open enrollment starts the first month a person is both enrolled in Part B and age 65 or older, lasts 6 months, and is a one-time opportunity that does not repeat each year. Medicare's annual open enrollment, by contrast, recurs every year for changing Medicare health and drug plan choices. See medicare.gov.

• A. It is administered entirely by the federal government with no state role
• B. It is a private insurance program subsidized through tax credits
• C. Each state funds its program alone, with no federal money
• D. States administer their own programs within federal requirements, with funding shared by the states and the federal government

Correct answer: D. States administer their own programs within federal requirements, with funding shared by the states and the federal government

Explanation: Medicaid is a joint federal-state program: each state administers its own program within federal guidelines, and costs are shared between the state and federal governments. Federal law requires states to cover certain mandatory groups, such as low-income families, qualified pregnant women and children, and SSI recipients. See medicaid.gov.

• A. By spending down: once her incurred medical expenses exceed the gap between her income and the state's medically needy income standard, she can become eligible
• B. By transferring her income to a relative the month before applying
• C. By paying a one-time enrollment fee to the state
• D. She cannot qualify under any circumstances once income exceeds the limit

Correct answer: A. By spending down: once her incurred medical expenses exceed the gap between her income and the state's medically needy income standard, she can become eligible

Explanation: States may operate a medically needy program for people with significant health needs whose income is too high for other eligibility groups. Such individuals spend down by incurring medical expenses; when those expenses exceed the difference between their income and the state's medically needy income level, Medicaid eligibility can begin. This contrasts with the categorically needy groups, who qualify by category and income alone. See medicaid.gov.

• A. Medicaid pays first and then bills the other insurers
• B. By law, all other available third parties must meet their legal obligation to pay claims before Medicaid pays
• C. Medicaid splits every claim 50/50 with any other insurer
• D. Medicaid only pays claims submitted in the last month of the year

Correct answer: B. By law, all other available third parties must meet their legal obligation to pay claims before Medicaid pays

Explanation: Medicaid generally pays only after other liable third parties, such as health insurers, liability insurers, and Medicare, have met their legal obligation to pay. States are required to take reasonable measures to identify such third-party liability. This is the opposite of primary coverage. See medicaid.gov.

• A. It must prevent any substantial gainful activity and be expected to last at least 12 continuous months or result in death
• B. It must prevent the worker's own occupation for at least 6 months
• C. It must prevent any work for at least 90 days
• D. Any doctor-certified illness qualifies regardless of duration

Correct answer: A. It must prevent any substantial gainful activity and be expected to last at least 12 continuous months or result in death

Explanation: Social Security defines disability as the inability to engage in any substantial gainful activity because of a medically determinable physical or mental impairment expected to result in death or to last for a continuous period of at least 12 months. Partial and short-term disabilities are not covered. See 42 U.S.C. 423(d) and ssa.gov.