UHC CERTIFICATION 2026/2027 | Questions with Complete
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UHC Medicare Advantage (Part C) Plans
Q1: A 68-year-old individual is newly eligible for Medicare Part A and Part B. They want
to enroll in a UHC Medicare Advantage plan. Their Initial Coverage Election Period
(ICEP) is:
A. January 1 to March 31 each year
B. The 3 months before, the month of, and the 3 months after their Part B entitlement
month [CORRECT]
C. October 15 to December 7 only
D. The month they turn 65 only
Correct Answer: B
Rationale: ICEP is the 7-month window surrounding Part B entitlement—3 months
before, month of, and 3 months after. Option A is OEP. Option C is AEP. Option D is too
narrow (IEP for Part B is 7 months, but ICEP for MA is specifically tied to Part B
entitlement timing).
Q2: A 72-year-old enrolled in a UHC Medicare Advantage HMO plan wants to see a
cardiologist for a heart condition. What is required?
A. No referral needed, direct access to any cardiologist
,B. A referral from their Primary Care Physician (PCP) to see an in-network specialist
[CORRECT]
C. Prior authorization only, no referral needed
D. They must switch to a PPO plan to see specialists
Correct Answer: B
Rationale: HMO plans require PCP referrals for specialist visits. PPO plans (A) don't
require referrals. Prior auth (C) may also be needed for certain services, but referral is
the HMO requirement. Switching plans (D) is unnecessary.
Q3: The Annual Enrollment Period (AEP) for Medicare Advantage and Part D plans
occurs:
A. January 1 through March 31
B. October 15 through December 7 [CORRECT]
C. July 1 through September 30
D. Year-round with no restrictions
Correct Answer: B
Rationale: AEP is October 15 - December 7 for enrolling in, disenrolling from, or
changing MA and Part D plans, with coverage effective January 1. Option A is OEP (for
MA enrollees only). Options C and D are incorrect.
Q4: A 67-year-old with both Medicare and Medicaid eligibility enrolls in a UHC Dual
Special Needs Plan (DSNP). This plan type:
,A. Requires the member to pay all cost-sharing out-of-pocket
B. Integrates Medicare and Medicaid benefits with enhanced coordination and reduced
cost-sharing [CORRECT]
C. Is only available to individuals under 65 with disabilities
D. Does not cover prescription drugs
Correct Answer: B
Rationale: DSNPs integrate Medicare and Medicaid benefits, provide care coordination,
and typically have reduced or eliminated cost-sharing for dual eligibles. Option A is
incorrect (cost-sharing is reduced). Option C is wrong age limit. Option D is incorrect
(DSNPs include Part D).
Q5: A member moves from Florida to Texas, outside their current UHC Medicare
Advantage plan's service area. They can enroll in a new plan using:
A. The Annual Enrollment Period only, waiting until October
B. A Special Enrollment Period (SEP) for moving out of the service area [CORRECT]
C. The Open Enrollment Period, but only if they pay a penalty
D. They must remain in their original plan and pay out-of-network costs
Correct Answer: B
Rationale: Moving out of a plan's service area qualifies for an SEP (2 months before to 2
months after the move). Option A forces unnecessary delay. Option C is incorrect about
penalties. Option D is incorrect (plan change is allowed and advisable).
, Q6: The Open Enrollment Period (OEP) for Medicare Advantage allows enrollees to:
A. Switch from Original Medicare to Medicare Advantage for the first time
B. Switch between MA plans or return to Original Medicare, January 1 - March 31
[CORRECT]
C. Enroll in Part D for the first time without penalty
D. Change Medigap plans without underwriting
Correct Answer: B
Rationale: OEP (Jan 1 - Mar 31) is for existing MA enrollees only to switch MA plans or
return to Original Medicare. Option A is IEP/AEP. Option C is not OEP function. Option D
is not applicable to MA.
Q7: A UHC Medicare Advantage plan member receives an Annual Wellness Visit (AWV).
Cost-sharing is:
A. Subject to the plan's standard office visit copay
B. $0 (no cost-sharing) when provided by an in-network provider [CORRECT]
C. Applied to the annual deductible first
D. 20% coinsurance after deductible is met
Correct Answer: B
Rationale: AWV is a Medicare-covered preventive service with $0 cost-sharing when
in-network. Not subject to cost-sharing (A, C, D).
Solutions | UnitedHealthcare Ethics & Compliance | Pass
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UHC Medicare Advantage (Part C) Plans
Q1: A 68-year-old individual is newly eligible for Medicare Part A and Part B. They want
to enroll in a UHC Medicare Advantage plan. Their Initial Coverage Election Period
(ICEP) is:
A. January 1 to March 31 each year
B. The 3 months before, the month of, and the 3 months after their Part B entitlement
month [CORRECT]
C. October 15 to December 7 only
D. The month they turn 65 only
Correct Answer: B
Rationale: ICEP is the 7-month window surrounding Part B entitlement—3 months
before, month of, and 3 months after. Option A is OEP. Option C is AEP. Option D is too
narrow (IEP for Part B is 7 months, but ICEP for MA is specifically tied to Part B
entitlement timing).
Q2: A 72-year-old enrolled in a UHC Medicare Advantage HMO plan wants to see a
cardiologist for a heart condition. What is required?
A. No referral needed, direct access to any cardiologist
,B. A referral from their Primary Care Physician (PCP) to see an in-network specialist
[CORRECT]
C. Prior authorization only, no referral needed
D. They must switch to a PPO plan to see specialists
Correct Answer: B
Rationale: HMO plans require PCP referrals for specialist visits. PPO plans (A) don't
require referrals. Prior auth (C) may also be needed for certain services, but referral is
the HMO requirement. Switching plans (D) is unnecessary.
Q3: The Annual Enrollment Period (AEP) for Medicare Advantage and Part D plans
occurs:
A. January 1 through March 31
B. October 15 through December 7 [CORRECT]
C. July 1 through September 30
D. Year-round with no restrictions
Correct Answer: B
Rationale: AEP is October 15 - December 7 for enrolling in, disenrolling from, or
changing MA and Part D plans, with coverage effective January 1. Option A is OEP (for
MA enrollees only). Options C and D are incorrect.
Q4: A 67-year-old with both Medicare and Medicaid eligibility enrolls in a UHC Dual
Special Needs Plan (DSNP). This plan type:
,A. Requires the member to pay all cost-sharing out-of-pocket
B. Integrates Medicare and Medicaid benefits with enhanced coordination and reduced
cost-sharing [CORRECT]
C. Is only available to individuals under 65 with disabilities
D. Does not cover prescription drugs
Correct Answer: B
Rationale: DSNPs integrate Medicare and Medicaid benefits, provide care coordination,
and typically have reduced or eliminated cost-sharing for dual eligibles. Option A is
incorrect (cost-sharing is reduced). Option C is wrong age limit. Option D is incorrect
(DSNPs include Part D).
Q5: A member moves from Florida to Texas, outside their current UHC Medicare
Advantage plan's service area. They can enroll in a new plan using:
A. The Annual Enrollment Period only, waiting until October
B. A Special Enrollment Period (SEP) for moving out of the service area [CORRECT]
C. The Open Enrollment Period, but only if they pay a penalty
D. They must remain in their original plan and pay out-of-network costs
Correct Answer: B
Rationale: Moving out of a plan's service area qualifies for an SEP (2 months before to 2
months after the move). Option A forces unnecessary delay. Option C is incorrect about
penalties. Option D is incorrect (plan change is allowed and advisable).
, Q6: The Open Enrollment Period (OEP) for Medicare Advantage allows enrollees to:
A. Switch from Original Medicare to Medicare Advantage for the first time
B. Switch between MA plans or return to Original Medicare, January 1 - March 31
[CORRECT]
C. Enroll in Part D for the first time without penalty
D. Change Medigap plans without underwriting
Correct Answer: B
Rationale: OEP (Jan 1 - Mar 31) is for existing MA enrollees only to switch MA plans or
return to Original Medicare. Option A is IEP/AEP. Option C is not OEP function. Option D
is not applicable to MA.
Q7: A UHC Medicare Advantage plan member receives an Annual Wellness Visit (AWV).
Cost-sharing is:
A. Subject to the plan's standard office visit copay
B. $0 (no cost-sharing) when provided by an in-network provider [CORRECT]
C. Applied to the annual deductible first
D. 20% coinsurance after deductible is met
Correct Answer: B
Rationale: AWV is a Medicare-covered preventive service with $0 cost-sharing when
in-network. Not subject to cost-sharing (A, C, D).
