UHC MEDICARE CERTIFICATION EXAM 2026

UHC MEDICARE CERTIFICATION EXAM 2025/2026
COMPLETE QUESTIONS WITH CORRECT DETAILED
ANSWERS
Good luck on your certification! Focus on enrollment periods, appeals processes, cost-sharing
rules, fraud/waste/abuse, and UHC-specific programs like HouseCalls and Renew Active. Those
areas appear most frequently on Medicare certification assessments.




DOMAIN 1: MEDICARE BASICS & ELIGIBILITY

1. At what age do most Americans become eligible for Medicare?

 A. 62
 B. 65 (correct answer)
 C. 67
 D. 70

RATIONALE: Most U.S. citizens and permanent residents become eligible for Medicare at
age 65. People under 65 may qualify due to disability (after 24 months of SSDI), End-Stage
Renal Disease (ESRD), or ALS.



2. Medicare Part A primarily covers:

 A. Outpatient physician visits
 B. Inpatient hospital stays, skilled nursing facility care, hospice, and home health
(correct answer)
 C. Prescription drugs
 D. Dental and vision care

RATIONALE: Medicare Part A is hospital insurance covering inpatient hospital care,
skilled nursing facility (SNF) care following a qualifying hospital stay, hospice care, and
some home health services.



3. Medicare Part B primarily covers:

,  A. Inpatient hospital care
 B. Outpatient medical services, physician visits, preventive services, and durable
medical equipment (correct answer)
 C. Prescription drug coverage
 D. Long-term custodial care

RATIONALE: Part B is medical insurance covering outpatient care, doctor services,
preventive services, lab tests, durable medical equipment (DME), and some home health
services.



4. Medicare Part C is also known as:

 A. Medigap
 B. Prescription Drug Plan
 C. Medicare Advantage (correct answer)
 D. Original Medicare

RATIONALE: Medicare Part C (Medicare Advantage) allows private insurance
companies like UHC to offer Medicare benefits. Plans must cover at least what Original
Medicare covers and often include additional benefits.



5. Medicare Part D covers:

 A. Inpatient hospital stays
 B. Physician office visits
 C. Outpatient prescription drugs (correct answer)
 D. Skilled nursing facility care

RATIONALE: Medicare Part D provides outpatient prescription drug coverage through
private insurers approved by Medicare. It was established by the Medicare Modernization
Act of 2003.



6. Which of the following individuals qualifies for Medicare before age 65?

 A. Someone who is unemployed
 B. Someone who has received Social Security Disability Insurance (SSDI) for 24
months (correct answer)
 C. Someone who is retired early
 D. Someone with high medical expenses

,RATIONALE: Individuals under 65 qualify for Medicare after receiving SSDI benefits for
24 months. Those with ALS qualify immediately; those with ESRD qualify after meeting
specific criteria.



7. The Initial Enrollment Period (IEP) for Medicare is:

 A. 3 months only
 B. 6 months
 C. 7 months — 3 months before, the month of, and 3 months after the 65th birthday
month (correct answer)
 D. 12 months

RATIONALE: The IEP is a 7-month window. Enrolling during the first 3 months (before
the birthday month) avoids delayed coverage start dates. Late enrollment may result in
permanent premium penalties.



8. What is the Medicare Part B late enrollment penalty?

 A. 1% per month for each month without coverage
 B. 10% per year for each full 12-month period without coverage (correct answer)
 C. 5% per year for each year without coverage
 D. A flat penalty fee of $500

RATIONALE: The Part B late enrollment penalty is 10% added to the standard premium
for each full 12-month period the beneficiary was eligible but did not enroll. This penalty is
permanent and lifelong.



9. The Medicare Part D late enrollment penalty is calculated as:

 A. $10 per month for each month without coverage
 B. 1% of the national base beneficiary premium per month without creditable
coverage (correct answer)
 C. 10% per year without coverage
 D. A fixed annual penalty

RATIONALE: The Part D penalty is 1% of the national base beneficiary premium
multiplied by the number of uncovered months. It is added to the monthly Part D premium
and is permanent.

, 10. Medicare's Annual Enrollment Period (AEP) runs from:

 A. January 1 – March 31
 B. July 1 – September 30
 C. October 15 – December 7 (correct answer)
 D. November 1 – January 31

RATIONALE: AEP (October 15–December 7) allows Medicare beneficiaries to switch,
join, or drop Medicare Advantage or Part D plans. Changes take effect January 1 of the
following year.



11. During the Medicare Advantage Open Enrollment Period (OEP), beneficiaries can:

 A. Switch to any plan available
 B. Switch from a Medicare Advantage plan to another MA plan or return to
Original Medicare (correct answer)
 C. Add Part D drug coverage only
 D. Change their Medigap policy

RATIONALE: The MA OEP (January 1–March 31) allows beneficiaries already enrolled
in an MA plan to make one change — switch to another MA plan or return to Original
Medicare. New enrollees cannot use this period.



12. Which statement about Medicare and employer coverage is correct?

 A. Medicare always pays first regardless of employer coverage
 B. For employers with 20+ employees, employer group health plan pays first;
Medicare pays secondary (correct answer)
 C. Medicare always pays secondary
 D. Employer coverage and Medicare never coordinate

RATIONALE: Coordination of Benefits (COB) rules: for active employees at employers
with 20+ workers, the group health plan is primary and Medicare is secondary. For
employers under 20, Medicare is primary.



DOMAIN 2: MEDICARE ADVANTAGE (PART C) PLANS

13. Medicare Advantage plans are required to cover:

 A. Only hospital care