CMAA Practice Exam 2025 – Complete Guide for Exam Prep

Insurance eligibility primarily determines whether a patient is covered for specific medical services under their insurance plan. This is a crucial aspect of medical administration, as it ensures that healthcare providers know which services are reimbursable by the insurance company and which are not. When assessing eligibility, administrative staff typically verify the patient's insurance details to confirm that the necessary treatments or services will be covered. This verification process helps prevent issues concerning payment for services rendered, thereby reducing financial strain on both the patient and the healthcare provider.

In this context, other options pertain to different aspects of health insurance but do not directly address the specific role of eligibility. The first option about the number of services a patient can receive in a year deals more with policy limitations or caps rather than eligibility itself. The amount of co-pay and the total deductible for the year relate to the patient’s cost-sharing responsibilities but do not influence whether treatments are covered under the patient's insurance plan, which is the core function of determining eligibility.