17 Free Missouri Accident & Health Exam Practice Questions (2026)

17 min read|Updated 2026-10-18

How to Use This Accident and Health Question Set

Missouri's Accident and Health Insurance Producer exam is one of three paths to a Health line of authority — the other two being the Life Insurance Producer exam on its own, and the combined Life, Accident and Health Insurance Producer exam that covers both lines in one sitting. Sat on its own, it delivers 90 scored questions plus 10 unscored pretest questions, in 2 hours, for $32 per attempt at a Pearson VUE test center. Passing takes a scaled score of 70 on a 0-100 scale, set by the Missouri Department of Commerce and Insurance together with Pearson VUE.

Pearson VUE's content outline splits the 90 scored items into Types of Policies (16), Policy Provisions, Clauses, and Riders (15), Social Insurance (6), Other Insurance Concepts (5), and Field Underwriting Procedures (8) — 50 general-knowledge items — plus 40 Missouri-specific items split evenly between law common to all lines (20) and law pertinent to accident and health insurance only (20). Missouri-specific law is nearly half the exam, the same split as the Life Insurance Producer exam.

These 17 questions come from chapters 4, 5 and 6 of LanePrep's Missouri Life, Accident & Health quiz bank, none of them repeated from the free 25-question sample across all three exam versions: six on accident and health policy types (chapter 4), six on policy provisions and social insurance (chapter 5), and five on other insurance concepts, field underwriting and Missouri law pertinent to accident and health insurance only (chapter 6). Each question shows its chapter, so a miss tells you exactly which audio lesson to replay.

Missouri does not require a pre-licensing course for Accident and Health Insurance Producer candidates. The NAIC's compiled pass-rate data puts the first-time pass rate at roughly 55-60% across the last two years — close to Life's own range, so neither line is one to guess through.

Work them before you read the answer. Every question has the explanation folded underneath it. Guessing and then reading is worth more than reading and then agreeing.

Practice Questions 1-6: Accident & Health Policy Types

Types of Policies is 16 of the Accident and Health Insurance Producer exam's 90 scored items, the largest single general-knowledge section. These six move through a PPO's out-of-network cost-sharing, the high-deductible health plan requirement behind HSA eligibility, a Medigap open enrollment period's guaranteed-issue protection, the activities of daily living a long-term care policy actually tracks, a hospital indemnity policy's flat per-day payout, and a critical illness policy's lump-sum benefit.

Question 1 (Chapter 4)

An individual is covered by a Preferred Provider Organization (PPO) plan. He decides to receive treatment from a provider who is not in the PPO's network. Which of the following is the most likely outcome?

A) The PPO will cover the service, but the insured will face higher out-of-pocket costs
B) The PPO will not cover any portion of the bill
C) The PPO will pay the same benefit as if the provider were in-network
D) The PPO will cancel the insured's coverage for going out-of-network

Show answer & explanation

Answer: A

Unlike HMOs, PPOs allow members to go out-of-network, but they incentivize using in-network providers by offering lower deductibles and coinsurance for network services. Out-of-network care is covered but at a higher cost to the insured.

Question 2 (Chapter 4)

A small business owner in Jefferson City wants to establish a Health Savings Account (HSA) for her employees. To be eligible to contribute to an HSA, what type of health insurance must the employees be enrolled in?

A) Any HMO or PPO with a zero-dollar copay
B) A Medicare Supplement Plan F
C) A Hospital Indemnity policy
D) A High-Deductible Health Plan (HDHP)

Show answer & explanation

Answer: D

Federal law (and Missouri tax treatment) requires that an individual be covered by a qualified High-Deductible Health Plan (HDHP) to be eligible to open and contribute to an HSA.

Question 3 (Chapter 4)

A 66-year-old Missouri resident recently enrolled in Medicare Part B. During her six-month Medigap open enrollment period, she applies for a Medicare Supplement policy. Which of the following is true regarding her application?

A) The insurer must issue the policy regardless of her health status
B) The insurer can charge her more if she has a history of heart disease
C) The insurer can deny coverage if she is a smoker
D) The insurer must wait two years before covering pre-existing conditions

Show answer & explanation

Answer: A

During the Medicare Supplement open enrollment period, policies are 'guaranteed issue.' Insurers cannot use medical underwriting to deny coverage or charge higher premiums based on health status or pre-existing conditions.

Question 4 (Chapter 4)

A Long-Term Care (LTC) policy in Missouri triggers benefits when the insured is unable to perform a certain number of Activities of Daily Living (ADLs). Which of the following is NOT considered a standard ADL?

A) Driving
B) Bathing
C) Eating
D) Transferring

Show answer & explanation

Answer: A

The six standard ADLs are bathing, dressing, toileting, transferring, continence, and eating. Driving is an 'Instrumental Activity of Daily Living' (IADL) but is not a standard trigger for LTC benefits.

Question 5 (Chapter 4)

An insured has a Hospital Indemnity policy that pays $150 per day for each day of hospitalization. If the insured is hospitalized for 4 days and the total hospital bill is $10,000, how much will the policy pay?

A) $10,000
B) $150
C) $0, because the bill exceeded the daily limit
D) $600

Show answer & explanation

Answer: D

Hospital Indemnity (or Fixed Indemnity) policies pay a flat dollar amount per day of hospitalization, regardless of the actual expenses incurred. 4 days x $150/day = $600.

Question 6 (Chapter 4)

A Missouri consumer purchases a Critical Illness policy with a $30,000 face amount. Two years later, he is diagnosed with a life-threatening cancer covered by the policy. How are the benefits typically paid?

A) As a lump sum payment to the insured upon diagnosis
B) As a reimbursement for medical bills as they are submitted
C) As a monthly income for the duration of the illness
D) Directly to the hospital to cover the deductible

Show answer & explanation

Answer: A

Critical Illness insurance is designed to pay a lump sum benefit directly to the insured upon the diagnosis of a specifically named illness (like cancer, heart attack, or stroke) to help with non-medical or out-of-pocket costs.

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Practice Questions 7-12: Policy Provisions and Social Insurance

Policy Provisions, Clauses, and Riders and Social Insurance together make up 21 of the exam's 90 scored items. These six move through a copayment calculation, the Reinstatement provision, what Medicare Part A actually covers, the income and asset limits behind Medicaid long-term care eligibility, the 24-month wait before SSDI recipients become eligible for Medicare, and a benefit-limit calculation.

Question 7 (Chapter 5)

A Missouri resident has a health insurance policy with a $25 copayment for office visits and a $10 copayment for generic prescriptions. If the resident visits the doctor 3 times and fills 2 generic prescriptions in a month, what is the total copayment amount due?

A) $35
B) $75
C) $115
D) $95

Show answer & explanation

Answer: D

Calculate the copayments: 3 office visits × $25 = $75. 2 generic prescriptions × $10 = $20. Total = $75 + $20 = $95. Option A is for one visit and one prescription, B is for 3 visits only, and C reflects incorrect arithmetic.

Question 8 (Chapter 5)

Which of the following is a mandatory provision in every Missouri accident and health insurance policy that allows the policyholder to put a lapsed policy back into force after non-payment of premium, subject to certain conditions?

A) Grace Period
B) Entire Contract
C) Incontestability Clause
D) Reinstatement

Show answer & explanation

Answer: D

The Reinstatement provision is a mandatory provision that allows a policyholder to apply to put a lapsed policy back into force. The insurer may require an application and proof of insurability, and if not rejected within 45 days, the policy is automatically reinstated. The Grace Period (A) allows temporary coverage after non-payment but does not restore a lapsed policy. Entire Contract (B) states the policy and application form the full agreement. Incontestability Clause (C) is not a standard term; the correct term is Time Limit on Certain Defenses.

Question 9 (Chapter 5)

A Missouri resident is eligible for Medicare. Which part of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care?

A) Medicare Part B
B) Medicare Part C
C) Medicare Part D
D) Medicare Part A

Show answer & explanation

Answer: D

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers outpatient/medical services like doctor visits and preventive care. Part C (Medicare Advantage) is an alternative way to receive Part A and B benefits. Part D covers prescription drugs. The question specifically describes Part A benefits.

Question 10 (Chapter 5)

Under Missouri law, which of the following statements is true regarding Medicaid eligibility for long-term care services?

A) Medicaid eligibility for long-term care is based solely on age, requiring the applicant to be 65 or older.
B) Individuals with unlimited assets can qualify for Medicaid long-term care by paying a monthly premium based on their income.
C) Medicaid automatically covers all nursing home costs for any Missouri resident who applies, regardless of financial situation.
D) Medicaid long-term care eligibility requires meeting both income and asset limits, which vary by state and are subject to look-back periods for asset transfers.

Show answer & explanation

Answer: D

Medicaid eligibility for long-term care services requires meeting both strict income and asset limits. Missouri, like all states, has specific thresholds and a look-back period (typically 5 years) to prevent asset transfers for the purpose of qualifying. Option A is incorrect because eligibility is not based solely on age. Option B is incorrect because paying a premium does not override asset limits. Option C is false; Medicaid is means-tested and not automatic.

Question 11 (Chapter 5)

A Missouri resident receives Social Security Disability Insurance (SSDI) benefits. After how many months of receiving SSDI benefits does the individual automatically become eligible for Medicare coverage?

A) 12 months
B) 36 months
C) 60 months
D) 24 months

Show answer & explanation

Answer: D

Individuals receiving Social Security Disability Insurance (SSDI) benefits are automatically enrolled in Medicare after a 24-month waiting period. This waiting period begins from the date they are first entitled to receive SSDI benefits. Options A, C, and D do not match the federal rule for SSDI-related Medicare eligibility.

Question 12 (Chapter 5)

A Missouri accident and health policy includes a benefit limit of $50,000 per year for physical therapy services. If the insured incurs $65,000 in covered physical therapy expenses in a policy year, how much will the insurer pay, assuming no deductible or coinsurance applies?

A) $15,000
B) $50,000
C) $65,000
D) $0

Show answer & explanation

Answer: B

When a policy has a benefit limit (or maximum) for a specific service, the insurer will pay up to that limit for covered expenses in the given period. Here, the limit is $50,000 per year for physical therapy. Even though expenses are $65,000, the insurer pays only $50,000, and the insured is responsible for the excess $15,000. Option A is the excess amount, C ignores the limit, and D is incorrect as expenses up to the limit are covered.

Practice Questions 13-17: Other Concepts, Field Underwriting and Missouri Accident & Health Law

Other Insurance Concepts, Field Underwriting Procedures, and Missouri law pertinent to accident and health insurance only together close out the outline. These five move through the difference between a required offer and a required benefit, the notice required before a drug moves to a higher cost-sharing tier, mental health parity in financial requirements and treatment limitations, how a long-term care policy evaluates a cognitive-impairment trigger, and the coordination of benefits rule that caps combined payments at 100% of the allowable expense.

Question 13 (Chapter 6)

In the context of Missouri health insurance law, which of the following is a required offer (not a required benefit) that insurers must make available to policyholders?

A) Coverage for mammography screenings
B) Coverage for autism spectrum disorder and applied behavior analysis
C) Coverage for chiropractic services
D) Coverage for diabetes management services

Show answer & explanation

Answer: D

Missouri law requires insurers to offer coverage for diabetes management services as a required offer, meaning it must be made available but the policyholder can reject it. Required benefits (like mammography, autism/ABA, and chiropractic services under certain conditions) must be included in the policy unless specifically rejected in writing. Diabetes management, along with speech/hearing services and chemotherapy, is listed as a required offer rather than a required benefit under Missouri statutes.

Question 14 (Chapter 6)

A Missouri resident with a health insurance policy receives a notice from their insurer stating that a prescribed medication is being moved to a higher cost-sharing tier, effective next month. This notice is required under which Missouri provision?

A) Grievance procedures
B) Formulary notification
C) Expedited review
D) Utilization review

Show answer & explanation

Answer: B

Missouri law requires health insurers to provide advance notice when a medication is moved to a higher cost-sharing tier or removed from the formulary. This is known as formulary notification. Grievance procedures address complaints about claim denials or coverage disputes. Expedited review is for urgent care situations. Utilization review evaluates the medical necessity of services.

Question 15 (Chapter 6)

Under Missouri law, which of the following statements is correct regarding mental health coverage in individual health insurance policies?

A) Insurers may impose annual visit limits on outpatient mental health services that are lower than those for physical health services.
B) Missouri law allows insurers to exclude coverage for substance use disorders if they also exclude certain mental health conditions.
C) Mental health coverage is only required in group health policies, not individual policies.
D) Coverage for mental health conditions must be provided with no greater financial requirements or treatment limitations than those applied to medical/surgical benefits.

Show answer & explanation

Answer: D

Missouri law requires parity in mental health coverage, meaning financial requirements (like deductibles and copays) and treatment limitations (like visit limits) for mental health and substance use disorder benefits cannot be more restrictive than those for medical/surgical benefits. This applies to both individual and group policies. Option A is incorrect because such limits would violate parity. Option B is incorrect as substance use disorder exclusions are also subject to parity rules. Option C is incorrect because the requirement applies to individual policies as well.

Question 16 (Chapter 6)

A Missouri resident with a long-term care insurance policy triggers benefits due to cognitive impairment. Which of the following activities is most likely used to determine eligibility for benefits under a typical long-term care policy?

A) Ability to perform instrumental activities of daily living (IADLs) like managing finances
B) Need for assistance with two or more activities of daily living (ADLs) such as bathing or dressing
C) Failure to pass a standardized test measuring memory and orientation
D) Diagnosis of a specific cognitive impairment like Alzheimer's disease by a physician

Show answer & explanation

Answer: C

Long-term care insurance policies typically use cognitive impairment assessments, such as standardized tests measuring memory and orientation (e.g., the Mini-Mental State Exam), to determine eligibility for benefits when cognitive impairment is the trigger. While need for assistance with ADLs is a common trigger for physical impairment, cognitive impairment triggers rely on evidence of severe cognitive loss. Diagnosis alone is usually insufficient; functional assessment via testing is required. IADLs are not the primary basis for benefit triggers in standard LTC policies.

Question 17 (Chapter 6)

Under Missouri law, which of the following statements is generally true regarding health insurance coverage for newborn children?

A) Coverage for a newborn child is available only if the insurer received and approved an application before the child was born.
B) Insurers may treat a newborn's congenital conditions as a pre-existing condition and exclude them from coverage.
C) A newly born child of the insured is automatically covered under the parent's policy from the moment of birth for an initial period, without requiring an additional application or premium for that period, but the policyholder must enroll the child to continue coverage beyond it.
D) Coverage for a newborn child is only available if the parents have a family plan; individual policies cannot cover dependents.

Show answer & explanation

Answer: C

Individual and group health policies generally include a newborn-coverage provision under which a child born to the insured is automatically covered from birth for an initial period without added premium or a formal application, but the policyholder must notify the insurer and enroll the child to continue coverage beyond that initial period. Congenital conditions are not treated as pre-existing conditions for purposes of denying newborn coverage. Option A is incorrect because a newborn cannot be applied for before birth. Option B is incorrect because congenital conditions are not excludable as pre-existing. Option D is incorrect because individual policies can include dependent coverage.

The Accident & Health Mistakes That Cost Marks

Reading an elimination period as if it shortens the payout rather than delaying it entirely. A hospital stay shorter than the stated elimination period pays nothing at all, not a prorated amount, and the same logic applies to a coinsurance or deductible calculation: the deductible comes out first, and only the remainder is split by the coinsurance percentage.

Mixing up the Reinstatement provision with the Time Limit on Certain Defenses provision. Reinstatement is about putting a lapsed policy back into force after nonpayment; the Time Limit on Certain Defenses provision is about how long after issue the insurer can still deny a claim over a misstatement on the application, unless that misstatement was fraudulent.

Treating Medicare and Medicaid as interchangeable for long-term care. Medicare Part A covers inpatient hospital stays, skilled nursing, hospice and some home health care, but not extended custodial long-term care; Medicaid is the program with its own income and asset limits, and its own look-back period, that actually covers that gap.

Confusing a required offer with a required benefit. A required offer, like diabetes management services, must be made available but can be rejected by the policyholder; a required benefit has to be in the policy regardless.

Assuming coordination of benefits lets an insured collect twice. It exists specifically to cap combined payments across every plan at 100% of the allowable expense, not to let a claim pay out more than once.

Chapters 4, 5 and 6 of the LanePrep Missouri course cover exactly this material as audio lessons, each with its own chapter quiz; chapters 1 and 9 preview free, no signup. For a 25-question sample across all three exam versions, see the free practice set; for the Life Insurance Producer exam, see the Life Insurance Producer question set.

Your Next Step

How did you score?

14 or more correct (82%+): You are comfortably in range for Missouri's scaled score of 70. Book the Accident and Health Insurance Producer exam (or the combined exam, if you are also sitting Life), then read how to pass the Missouri Life & Health exam on the first try for the full study plan.

11-13 correct: You are in range but close to the line. Note which chapter your misses fell in and re-listen to that chapter's audio lesson before retesting.

Under 11 correct: The Accident and Health Insurance Producer exam's first-time pass rate has run 55-60% over the last two years. Start with chapter 4 of the course and work forward rather than guessing through another set.

Chapters 1 and 9 of the LanePrep Missouri course are free at /mo/l-and-h/preview — full audio and the chapter quiz, no signup. For the full cost picture, see how much a Missouri L&H license costs.

Exam structure, fees and passing score from Pearson VUE's Missouri Insurance Licensing Candidate Handbook (Stock #1226-00, 03/2026). Content outline weights from Pearson VUE's Missouri Insurance Content Outlines #122601 (effective February 1, 2026) for the Accident and Health Insurance Producer exam. Pass rates from the NAIC 2024 and 2025 compiled pass-rate reports. Read October 2026.

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