Washington Health Insurance Practice Exam Free 2026

• A. Guaranteed issue for groups
• B. Guaranteed new policy issuance
• C. The insurer must renew coverage as long as premiums are paid
• D. Renewal of gym memberships

Correct answer: C. The insurer must renew coverage as long as premiums are paid

Explanation: Guaranteed renewability means the insurer cannot refuse to renew coverage as long as premiums are paid. The insurer can increase premiums for the entire class but cannot single out individuals.

• A. Retroactive cancellation of coverage due to fraud or intentional misrepresentation
• B. Reducing coverage amounts
• C. A recession in the economy
• D. Policy renewal

Correct answer: A. Retroactive cancellation of coverage due to fraud or intentional misrepresentation

Explanation: Rescission is the retroactive cancellation of a health insurance policy, typically due to fraud or intentional misrepresentation on the application. Under the ACA, rescissions are limited to fraud cases.

• A. A benefits summary for employees
• B. A brief policy overview
• C. A coverage limitation list
• D. A standardized document explaining what a health plan covers in plain language

Correct answer: D. A standardized document explaining what a health plan covers in plain language

Explanation: The SBC is a standardized document required by the ACA that explains health plan coverage in plain language using a consistent format, making it easier to compare different plans.

• A. Medical equipment depreciation
• B. The ratio of losses to gains
• C. The percentage of premiums an insurer must spend on medical care and quality improvement
• D. The amount of money lost to medical bills

Correct answer: C. The percentage of premiums an insurer must spend on medical care and quality improvement

Explanation: MLR is the percentage of premium dollars insurers must spend on medical care and quality improvement. The ACA requires 80% for individual/small group and 85% for large group plans.

• A. A plan certified by the Marketplace meeting ACA standards
• B. A Medicare-approved plan
• C. Any health insurance plan
• D. A qualified employee benefit plan

Correct answer: A. A plan certified by the Marketplace meeting ACA standards

Explanation: A QHP is a health insurance plan certified by the Health Insurance Marketplace to meet ACA standards, including essential health benefits, cost-sharing limits, and other consumer protections.

• A. Basic hospital services only
• B. Emergency-only coverage
• C. Ten categories of services all Marketplace plans must cover under the ACA
• D. Benefits essential for insurance companies

Correct answer: C. Ten categories of services all Marketplace plans must cover under the ACA

Explanation: Essential health benefits are 10 categories of services that ACA-compliant plans must cover: ambulatory, emergency, hospitalization, maternity, mental health, prescription drugs, rehabilitative, lab, preventive, and pediatric services.

• A. A tax on insurance premiums
• B. A credit for paying premiums on time
• C. A subsidy to help eligible individuals afford Marketplace health insurance
• D. A premium discount

Correct answer: C. A subsidy to help eligible individuals afford Marketplace health insurance

Explanation: Premium tax credits are subsidies provided under the ACA to help eligible individuals and families with moderate incomes afford health insurance purchased through the Marketplace.

• A. Sharing medical costs with family
• B. Subsidies that lower deductibles, copays, and out-of-pocket limits for eligible individuals
• C. Cost reduction strategies for hospitals
• D. Reducing costs between insurers

Correct answer: B. Subsidies that lower deductibles, copays, and out-of-pocket limits for eligible individuals

Explanation: Cost-sharing reductions are subsidies that lower out-of-pocket costs (deductibles, copays, coinsurance) for eligible individuals who choose Silver tier Marketplace plans and meet income requirements.

• A. A period for special students to enroll
• B. Early enrollment period
• C. Special enrollment for seniors
• D. A time outside open enrollment when qualifying life events allow health plan enrollment

Correct answer: D. A time outside open enrollment when qualifying life events allow health plan enrollment

Explanation: A SEP is a time outside the regular open enrollment period when you can enroll in health coverage due to a qualifying life event such as marriage, birth of a child, loss of other coverage, or moving.

• A. To set the insurance company's premiums
• B. To act as the member's main doctor and coordinate care within the network
• C. To sell supplemental disability insurance
• D. To approve every life insurance beneficiary change

Correct answer: B. To act as the member's main doctor and coordinate care within the network

Explanation: In many HMO arrangements, the primary care physician coordinates routine care and may provide referrals to specialists within the network.

• A. It usually gives members more provider flexibility than an HMO
• B. It never uses a provider network
• C. It only pays benefits after retirement
• D. It is a form of life insurance

Correct answer: A. It usually gives members more provider flexibility than an HMO

Explanation: A preferred provider organization usually lets members use network providers at better cost sharing while still offering some coverage for out-of-network care.

• A. A death certificate
• B. A referral from the primary care physician
• C. A property inspection
• D. A workers compensation claim form

Correct answer: B. A referral from the primary care physician

Explanation: Gatekeeper HMO models commonly require the primary care physician to coordinate specialist referrals so care stays within the plan's managed network.