WELLCARE ACT MASTERY EXAM PRACTICE TEST
(2025/2026 UPDATED STANDARDS) WELLCARE HEALTH
PLANS | 2025/2026 QUESTIONS AND ANSWERS.
INTRODUCTION:
This comprehensive practice examination is designed to prepare insurance agents, brokers, and
healthcare professionals for the WellCare ACT Mastery Examination certification. The test is
based on current 2025/2026 CMS guidelines, WellCare-specific protocols, and federal Medicare
regulations to ensure complete alignment with certification standards. Candidates must achieve
a passing score of 85% or higher to successfully complete this course and demonstrate
competency in Medicare Advantage products, enrollment procedures, compliance requirements,
Fraud Waste & Abuse prevention, HIPAA privacy protections, and WellCare-specific plan
benefits. This exam covers all six core domains required for certification and reflects the most
current regulatory updates affecting Medicare Advantage and Part D operations.
DOMAIN 1: MEDICARE ADVANTAGE & PART D FUNDAMENTALS (Questions 1-20)
Question 1: Low-Income Subsidy (LIS), often referred to as Extra Help, reduces all Part D plan
premiums.
A. True
B. False
Answer: B
Rationale: This statement is FALSE. While LIS provides significant premium and cost-sharing
assistance, it does not eliminate all Part D plan premiums. Beneficiaries are responsible for
paying any premium amount that exceeds the LIS subsidy amount for their specific category
level. [citation:3][citation:4][citation:7]
Question 2: All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive
vaccines, regardless of which network pharmacy is used by members.
A. $0
B. $5
C. $10
D. $20
Answer: A
,Rationale: CMS mandates that all PDPs offer a $0 copay for most Part D preventive vaccines
(such as shingles, Tdap, and pneumococcal vaccines) at all network pharmacies, ensuring
beneficiaries have barrier-free access to preventive care regardless of pharmacy location.
[citation:3][citation:5][citation:7]
Question 3: In the Catastrophic Coverage stage, the member will pay $0 for brand and generic
drugs for the remainder of the year once their total out-of-pocket costs reach what amount?
A. $6,000
B. $7,000
C. $8,000
D. $9,000
Answer: C
Rationale: Under the Inflation Reduction Act of 2022, once a beneficiary's total out-of-pocket
costs reach $8,000 (true out-of-pocket or TrOOP costs), they enter the Catastrophic Coverage
stage and pay $0 for all covered brand and generic drugs for the remainder of the calendar year.
[citation:3][citation:4][citation:7]
Question 4: Members are no longer required to pay a partial deductible due to the Inflation
Reduction Act provisions.
A. True
B. False
Answer: A
Rationale: This statement is TRUE. The Inflation Reduction Act eliminated the partial deductible
requirement for Medicare Part D coverage, simplifying the benefit structure and reducing
upfront costs for beneficiaries entering the prescription drug coverage gap.
[citation:4][citation:7]
Question 5: The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin
copays for all insulins and insulin-combination products that are on the formulary, regardless of
tier, and are included in the $35 cap for one month's supply.
A. True
B. False
Answer: A
,Rationale: This statement is TRUE. The IRA establishes a $35 monthly cap on insulin costs for all
covered insulin products and insulin-combination products on the formulary, regardless of
which tier they are assigned, significantly reducing costs for diabetic beneficiaries.
[citation:7][citation:9]
Question 6: How many Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states
and Washington, D.C. under WellCare's 2025 portfolio?
A. One
B. Two
C. Three
D. Five
Answer: C
Rationale: WellCare offers three distinct Prescription Drug Plans (PDPs) that are available across
all 50 U.S. states and Washington, D.C., providing consistent coverage options regardless of
geographic location. [citation:4][citation:7][citation:10]
Question 7: The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective January
1, 2024, impacts which types of WellCare plans?
A. PDP plans only
B. MAPD plans only
C. Both PDP and MAPD plans
D. Neither PDP nor MAPD plans
Answer: C
Rationale: The PBM migration to Express Scripts affects both Prescription Drug Plans (PDPs) and
Medicare Advantage Prescription Drug (MAPD) plans, requiring agents to understand new
pharmacy networks, mail order options, and formulary management for all WellCare products
with drug coverage. [citation:4][citation:7][citation:9]
Question 8: A Low-Income Subsidy (LIS) member will be assigned one of how many copay
categories depending on the level of need?
A. Two
B. Three
, C. Four
D. Six
Answer: C
Rationale: LIS members are assigned to one of four distinct copay categories based on their
income and resource levels, with each category determining the specific premium and cost-
sharing assistance amounts they receive, ranging from full subsidy to partial subsidy levels.
[citation:4][citation:7][citation:9]
Question 9: CVS Caremark Mail Order will NOT be in-network for 2024 WellCare plans.
A. True
B. False
Answer: B
Rationale: This statement is FALSE. While Express Scripts serves as the preferred mail order
network, CVS Caremark Mail Order remains an in-network option for WellCare members.
Agents must clarify that Express Scripts is the preferred mail order pharmacy, not the exclusive
option. [citation:4][citation:7][citation:9]
Question 10: The Medicare Prescription Payment Plan allows prescription costs to be spread
across monthly payments billed directly to whom?
A. The pharmacy
B. The member
C. The plan sponsor
D. CMS
Answer: B
Rationale: The Medicare Prescription Payment Plan is designed to help beneficiaries manage
high prescription drug costs by spreading payments across monthly installments that are billed
directly to the member, not the pharmacy or other entities, improving affordability through
payment smoothing. [citation:10]
Question 11: All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug
coverage include a $0 copay Tier 6 at all in-network pharmacy locations.
A. True
(2025/2026 UPDATED STANDARDS) WELLCARE HEALTH
PLANS | 2025/2026 QUESTIONS AND ANSWERS.
INTRODUCTION:
This comprehensive practice examination is designed to prepare insurance agents, brokers, and
healthcare professionals for the WellCare ACT Mastery Examination certification. The test is
based on current 2025/2026 CMS guidelines, WellCare-specific protocols, and federal Medicare
regulations to ensure complete alignment with certification standards. Candidates must achieve
a passing score of 85% or higher to successfully complete this course and demonstrate
competency in Medicare Advantage products, enrollment procedures, compliance requirements,
Fraud Waste & Abuse prevention, HIPAA privacy protections, and WellCare-specific plan
benefits. This exam covers all six core domains required for certification and reflects the most
current regulatory updates affecting Medicare Advantage and Part D operations.
DOMAIN 1: MEDICARE ADVANTAGE & PART D FUNDAMENTALS (Questions 1-20)
Question 1: Low-Income Subsidy (LIS), often referred to as Extra Help, reduces all Part D plan
premiums.
A. True
B. False
Answer: B
Rationale: This statement is FALSE. While LIS provides significant premium and cost-sharing
assistance, it does not eliminate all Part D plan premiums. Beneficiaries are responsible for
paying any premium amount that exceeds the LIS subsidy amount for their specific category
level. [citation:3][citation:4][citation:7]
Question 2: All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive
vaccines, regardless of which network pharmacy is used by members.
A. $0
B. $5
C. $10
D. $20
Answer: A
,Rationale: CMS mandates that all PDPs offer a $0 copay for most Part D preventive vaccines
(such as shingles, Tdap, and pneumococcal vaccines) at all network pharmacies, ensuring
beneficiaries have barrier-free access to preventive care regardless of pharmacy location.
[citation:3][citation:5][citation:7]
Question 3: In the Catastrophic Coverage stage, the member will pay $0 for brand and generic
drugs for the remainder of the year once their total out-of-pocket costs reach what amount?
A. $6,000
B. $7,000
C. $8,000
D. $9,000
Answer: C
Rationale: Under the Inflation Reduction Act of 2022, once a beneficiary's total out-of-pocket
costs reach $8,000 (true out-of-pocket or TrOOP costs), they enter the Catastrophic Coverage
stage and pay $0 for all covered brand and generic drugs for the remainder of the calendar year.
[citation:3][citation:4][citation:7]
Question 4: Members are no longer required to pay a partial deductible due to the Inflation
Reduction Act provisions.
A. True
B. False
Answer: A
Rationale: This statement is TRUE. The Inflation Reduction Act eliminated the partial deductible
requirement for Medicare Part D coverage, simplifying the benefit structure and reducing
upfront costs for beneficiaries entering the prescription drug coverage gap.
[citation:4][citation:7]
Question 5: The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin
copays for all insulins and insulin-combination products that are on the formulary, regardless of
tier, and are included in the $35 cap for one month's supply.
A. True
B. False
Answer: A
,Rationale: This statement is TRUE. The IRA establishes a $35 monthly cap on insulin costs for all
covered insulin products and insulin-combination products on the formulary, regardless of
which tier they are assigned, significantly reducing costs for diabetic beneficiaries.
[citation:7][citation:9]
Question 6: How many Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states
and Washington, D.C. under WellCare's 2025 portfolio?
A. One
B. Two
C. Three
D. Five
Answer: C
Rationale: WellCare offers three distinct Prescription Drug Plans (PDPs) that are available across
all 50 U.S. states and Washington, D.C., providing consistent coverage options regardless of
geographic location. [citation:4][citation:7][citation:10]
Question 7: The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective January
1, 2024, impacts which types of WellCare plans?
A. PDP plans only
B. MAPD plans only
C. Both PDP and MAPD plans
D. Neither PDP nor MAPD plans
Answer: C
Rationale: The PBM migration to Express Scripts affects both Prescription Drug Plans (PDPs) and
Medicare Advantage Prescription Drug (MAPD) plans, requiring agents to understand new
pharmacy networks, mail order options, and formulary management for all WellCare products
with drug coverage. [citation:4][citation:7][citation:9]
Question 8: A Low-Income Subsidy (LIS) member will be assigned one of how many copay
categories depending on the level of need?
A. Two
B. Three
, C. Four
D. Six
Answer: C
Rationale: LIS members are assigned to one of four distinct copay categories based on their
income and resource levels, with each category determining the specific premium and cost-
sharing assistance amounts they receive, ranging from full subsidy to partial subsidy levels.
[citation:4][citation:7][citation:9]
Question 9: CVS Caremark Mail Order will NOT be in-network for 2024 WellCare plans.
A. True
B. False
Answer: B
Rationale: This statement is FALSE. While Express Scripts serves as the preferred mail order
network, CVS Caremark Mail Order remains an in-network option for WellCare members.
Agents must clarify that Express Scripts is the preferred mail order pharmacy, not the exclusive
option. [citation:4][citation:7][citation:9]
Question 10: The Medicare Prescription Payment Plan allows prescription costs to be spread
across monthly payments billed directly to whom?
A. The pharmacy
B. The member
C. The plan sponsor
D. CMS
Answer: B
Rationale: The Medicare Prescription Payment Plan is designed to help beneficiaries manage
high prescription drug costs by spreading payments across monthly installments that are billed
directly to the member, not the pharmacy or other entities, improving affordability through
payment smoothing. [citation:10]
Question 11: All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug
coverage include a $0 copay Tier 6 at all in-network pharmacy locations.
A. True
