16 Free Pennsylvania Medigap, Long-Term Care and Senior Health Practice Questions (2026)
How to Use This Senior Health Question Set
Senior Citizens and Special Needs is its own line on the PSI Series 16-03 content outline, worth 7% of the exam — 10 to 11 of the 150 scored questions — and it covers Medicare, Medigap and long-term care insurance. It is not the only place Pennsylvania-specific law shows up, though: the outline weaves state rules through several sections rather than keeping them in one state-law block, and a number of Pennsylvania's mandated health benefits — newborn coverage, mental health parity, oral chemotherapy parity — are tested as part of the Medical Plans and General Insurance Concepts sections that sit next to Senior Citizens and Special Needs in the course.
Medicare's enrollment windows and penalties are federal, but Pennsylvania layers its own rules on top: a 6-month Medigap open enrollment window tied to Part B enrollment (31 Pa. Code Ch. 89.778), a prohibition on implying federal endorsement when marketing a Medicare Supplement policy (31 Pa. Code Ch. 89.786), and a 30-day free look and a right to name a third party to receive a lapse notice on a long-term care policy (40 P.S. § 991.1110, 31 Pa. Code Ch. 89a.106).
These 16 questions come from chapter 8 of LanePrep's Pennsylvania Life & Health quiz bank and follow the three ways the exam approaches the topic: Medicare, Medicare Advantage and Medigap rules; long-term care insurance; and Pennsylvania's mandated health benefits.
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 1-8: Medicare, Medicare Advantage and Medigap Rules
The first two separate what Part A and Part B each cover, the third asks what a Medicare Advantage plan replaces, and the rest move into Pennsylvania's Medigap rules specifically: the 6-month open enrollment window, the marketing practice that is always prohibited, the suitability review a producer must perform, the guaranteed-issue right and how a Medicare Select plan differs from a standard Medigap policy.
Question 1 (Chapter 8)
Regarding Medicare Part B, which of the following services is typically covered for a Pennsylvania resident?
- A) Routine dental care and dentures.
- B) Long-term custodial care in a nursing home.
- C) Prescription drugs for outpatient use.
- D) Medically necessary outpatient services and physician visits.
Show answer & explanation
Answer: D
Medicare Part B (Medical Insurance) covers medically necessary services such as doctor visits, outpatient care, and medical supplies. Dental care and long-term custodial care are generally excluded.
Question 2 (Chapter 8)
A Pennsylvania resident is enrolled in Medicare Part A. What does this part of Medicare primarily cover?
- A) Physician services and outpatient care
- B) Inpatient hospital care, skilled nursing facility care, and hospice
- C) Prescription drugs
- D) Medicare Advantage plans
Show answer & explanation
Answer: B
Medicare Part A is hospital insurance, covering inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care.
Question 3 (Chapter 8)
A Pennsylvania resident is enrolled in a Medicare Advantage (Part C) plan. What does this plan typically provide?
- A) Coverage that replaces Original Medicare (Parts A and B) and often includes prescription drug coverage.
- B) Only supplemental coverage for hospital costs.
- C) Coverage only for hospice care.
- D) Coverage only for out-of-pocket expenses not covered by Medicare.
Show answer & explanation
Answer: A
Medicare Advantage (Part C) plans are offered by private companies approved by Medicare and provide an alternative to Original Medicare, often bundling hospital, medical, and prescription drug coverage.
Question 4 (Chapter 8)
A senior citizen in Pennsylvania is applying for a Medicare Supplement (Medigap) policy. Under 31 Pa. Code Ch. 89.778, what is the 'open enrollment' period?
- A) A 6-month period beginning when the individual is 65 or older and enrolled in Medicare Part B.
- B) A 30-day period starting the day after the policy is issued.
- C) A 12-month period that occurs every year in January.
- D) Only available during the annual Medicare Advantage disenrollment period.
Show answer & explanation
Answer: A
31 Pa. Code Ch. 89.778 provides a 6-month open enrollment period for Medicare Supplement policies, which begins when an individual is age 65 or older and enrolled in Medicare Part B.
Question 5 (Chapter 8)
An insurer is marketing a Medicare Supplement policy in Pennsylvania. Under 31 Pa. Code Ch. 89.786, which of the following actions is strictly prohibited during the marketing process?
- A) Providing the applicant with the required Outline of Coverage
- B) Using the term 'Medicare Supplement' to describe the policy
- C) Representing that the policy is endorsed by the federal government
- D) Explaining the differences between Plan A and Plan F
Show answer & explanation
Answer: C
Marketing standards for Medicare Supplement policies prohibit any representation that implies the policy is endorsed, sponsored, or approved by the federal government or any state agency. Options A, B, and D are standard and required practices.
Question 6 (Chapter 8)
A 70-year-old Pennsylvania resident is applying for a Medicare Supplement policy. The producer is reviewing the 'suitability' of the purchase. Under 31 Pa. Code Ch. 89.787, which factor must the producer evaluate?
- A) The applicant's credit score.
- B) Whether the applicant already has a Medigap policy and if the new policy will replace existing coverage.
- C) The applicant's political affiliation.
- D) The applicant's ability to pass a physical examination.
Show answer & explanation
Answer: B
Suitability standards are designed to prevent the sale of excessive or redundant coverage. Producers must determine if the new policy is replacing an existing one and if the purchase is appropriate for the applicant's needs.
Question 7 (Chapter 8)
A Pennsylvania resident is looking for a Medicare Supplement plan. Which of the following is true regarding the 'guaranteed issue' right for Medigap in Pennsylvania?
- A) It is only available to those under age 65
- B) It allows individuals to purchase a policy regardless of health status during specific enrollment periods
- C) It requires the applicant to pass a medical exam
- D) It is only available for Plan F
Show answer & explanation
Answer: B
Guaranteed issue rights allow eligible individuals to purchase a Medicare Supplement policy without medical underwriting during specific windows, regardless of their health status.
Question 8 (Chapter 8)
A Pennsylvania resident is considering a 'Medicare Select' plan. How does this differ from a standard Medicare Supplement plan?
- A) It is a government-run plan, not a private plan.
- B) It provides no coverage for hospital stays.
- C) It requires the use of a specific network of providers to receive full benefits.
- D) It is only available to individuals under age 65.
Show answer & explanation
Answer: C
Medicare Select is a type of Medicare Supplement policy that requires the insured to use a network of healthcare providers to receive full benefits, unlike standard Medigap plans.
Get the 25-question sample set by email
Want a full-exam practice set to study offline? Drop your email — we'll send 25 questions across every content area, each with the answer and explanation.
No spam. Just the questions and one optional follow-up.
Practice Questions 9-13: Long-Term Care Insurance
Five separate consumer protections apply to a Pennsylvania long-term care policy, and the exam tests them as five separate questions rather than one topic: the 30-day free look, the Activities-of-Daily-Living benefit trigger, the requirement to offer inflation protection, the nonforfeiture benefit and the right to name someone to receive a lapse notice.
Question 9 (Chapter 8)
A Pennsylvania resident purchases a long-term care (LTC) policy on July 1st. On July 15th, they decide the policy is too expensive and wish to cancel it. According to 40 P.S. § 991.1110, what is the minimum free-look period for this LTC policy?
- A) 10 days
- B) 20 days
- C) 45 days
- D) 30 days
Show answer & explanation
Answer: D
Under 40 P.S. § 991.1110, Pennsylvania law mandates a minimum 30-day free-look period for long-term care insurance policies, allowing the policyholder to return the policy for a full refund of any premiums paid.
Question 10 (Chapter 8)
A client is interested in Long-Term Care (LTC) insurance. Which of the following is a 'benefit trigger' that would allow them to receive benefits under 31 Pa. Code Ch. 89a.124?
- A) A physician's certification that the insured is unable to perform a specified number of Activities of Daily Living (ADLs).
- B) The insured reaching the age of 80, regardless of health status.
- C) The insured being admitted to a hospital for any reason for more than 24 hours.
- D) The insured choosing to retire from their primary occupation.
Show answer & explanation
Answer: A
LTC policies typically use the inability to perform a specified number of Activities of Daily Living (ADLs) or cognitive impairment as the trigger for benefit payments under 31 Pa. Code Ch. 89a.124.
Question 11 (Chapter 8)
Under Pennsylvania law, what is the 'inflation protection' requirement for Long-Term Care policies (31 Pa. Code Ch. 89a.112)?
- A) The insurer must automatically increase the benefit amount by 10% every year.
- B) Inflation protection is not required in Pennsylvania.
- C) The insurer must offer the applicant the option to purchase inflation protection.
- D) The insurer must provide a fixed benefit that never changes.
Show answer & explanation
Answer: C
31 Pa. Code Ch. 89a.112 requires that insurers offer applicants the option to purchase inflation protection to ensure that benefits keep pace with rising long-term care costs.
Question 12 (Chapter 8)
A policyholder has an LTC policy with a 'nonforfeiture benefit.' What does this benefit provide?
- A) A refund of all premiums paid if no claims are made
- B) Automatic renewal of the policy regardless of health status
- C) A reduced paid-up benefit if the policyholder stops paying premiums
- D) A waiver of premium during periods of disability
Show answer & explanation
Answer: C
A nonforfeiture benefit ensures that if a policyholder stops paying premiums after a certain period, they do not lose all the value of the policy, often resulting in a reduced, paid-up benefit.
Question 13 (Chapter 8)
A Pennsylvania resident with a long-term care policy faces a potential lapse due to non-payment of premium. Under 31 Pa. Code Ch. 89a.106, what is the insurer required to do to prevent an unintentional lapse?
- A) Provide a 30-day grace period only if requested by the policyholder.
- B) Allow the policyholder to designate at least one person to receive a notice of lapse if the premium is not paid.
- C) Automatically reinstate the policy within 90 days of termination.
- D) Notify the Pennsylvania Insurance Department before canceling the coverage.
Show answer & explanation
Answer: B
31 Pa. Code Ch. 89a.106 requires LTC insurers to offer the policyholder the right to designate a third party to receive notice of an impending lapse, protecting seniors who might forget to pay or suffer cognitive decline.
Practice Questions 14-16: Pennsylvania's Mandated Health Benefits
Pennsylvania statute mandates specific coverage in specific terms, and the exam tests the exact requirement rather than the general idea: newborn coverage from the moment of birth, serious mental illness treated at parity with physical illness, and oral chemotherapy covered no less favorably than intravenous chemotherapy.
Question 14 (Chapter 8)
A child is born to a policyholder with a family health plan. Under 40 P.S. §§ 771–775.2, when must coverage for the newborn begin?
- A) From the moment of birth.
- B) Only after the child is 30 days old.
- C) Only if the parent pays an additional premium within 60 days.
- D) Only after the child is discharged from the hospital.
Show answer & explanation
Answer: A
Pennsylvania law (40 P.S. §§ 771–775.2) requires that health insurance policies providing family coverage must cover newborn children from the moment of birth.
Question 15 (Chapter 8)
A policyholder with a serious mental illness (as defined in 40 P.S. § 764g) seeks treatment under their group health plan. What does Pennsylvania law require regarding this coverage?
- A) Coverage must be provided at parity with the coverage provided for other physical illnesses.
- B) Coverage can be limited to 10 outpatient visits per year.
- C) Coverage is only required if the policyholder pays an additional premium for a mental health rider.
- D) Coverage is limited to inpatient hospitalization only.
Show answer & explanation
Answer: A
40 P.S. § 764g requires that health insurance policies provide coverage for serious mental illness at parity with the benefits provided for other physical illnesses.
Question 16 (Chapter 8)
Under 40 P.S. § 764b, Pennsylvania health insurance policies must provide coverage for cancer therapy. What is the specific requirement regarding orally administered chemotherapy medication?
- A) Coverage for oral chemotherapy must not be less favorable than coverage for intravenous chemotherapy
- B) It must be covered at a lower cost than intravenously administered chemotherapy
- C) It is exempt from the policy's annual deductible
- D) It is only covered if the patient is hospitalized
Show answer & explanation
Answer: A
Act 73 of 2016 (amending 40 P.S. § 764b) mandates that health insurance policies must ensure that coverage for orally administered chemotherapy is not less favorable than the coverage provided for intravenously administered chemotherapy.
The Senior Health and Long-Term Care Mistakes That Cost Marks
Putting the physician's bill on Part A. Part A pays the inpatient hospital, skilled nursing and hospice facility costs; Part B pays the physician and outpatient services, even during an inpatient stay.
Tying Medigap open enrollment to age alone. The 6-month window under 31 Pa. Code Ch. 89.778 begins when the individual is 65 or older and enrolled in Medicare Part B — both conditions have to be met, not just the birthday.
Confusing the three long-term care consumer protections. The free look lets a new policyholder cancel within 30 days for a refund. The nonforfeiture benefit protects someone who stops paying premiums after the policy has been in force. Inflation protection is an option the insurer must offer, not a benefit that is automatically included. They answer three different questions.
Treating a benefit trigger as age- or diagnosis-based. Long-term care benefits turn on a physician's certification that the insured cannot perform a specified number of Activities of Daily Living, or has a cognitive impairment — not on reaching a certain age or being hospitalized for any reason.
Rounding a mandated benefit down to a general principle. 'Pennsylvania covers newborns' is not specific enough for the exam; the statute requires coverage from the moment of birth, with no waiting period and no separate premium notice deadline built into the benefit itself. The same is true of the parity requirements for mental health and oral chemotherapy — the exam wants the exact standard, not the approximate one.
Chapter 8 of the LanePrep Pennsylvania course covers Medicare, Medigap, long-term care and the mandated health benefits as an audio lesson. Chapters 1 and 9 are free, no signup. For a sample across the whole exam, the 25-question set covers every content area; for the largest single section, see the insurance regulation set.
Question counts and content weighting come from the PSI content outline, Series 16-03 Life, Accident and Health (in force from March 1, 2026). Read October 2026.
Free: 25 Pennsylvania L&H practice questions
Liked this article? Get 25 exam-style questions emailed to you — with full answer explanations, no credit card. Closest thing to studying offline.
No spam. Just the questions and one optional follow-up.
Study this topic with LanePrep
Listen to these audio chapters on your commute — no screen required.
Related Articles
How to Pass the Pennsylvania Life & Health Exam on Your First Try (2026)
8 min read
$122.50 + Fingerprints: Pennsylvania Life & Health License Cost 2026
7 min read
25 Free Pennsylvania Life & Health Exam Practice Questions (2026)
18 min read
18 Free Pennsylvania Insurance Regulation Practice Questions (2026)
14 min read