UHC Certification 2025/2026 Questions With
Complete Solutions
1. Which statement is true about the Medicare Advantage (MA) Out- of pocket Maximum?
- ANSWER-All MA plans have an Out- of Pocket maximum to help limit the member's out
of pocket cost for Medicare-covered services.
2. A consumer currently has Original Medicare and is enrolled in a stand alone PDP. What
will happen if the consumer enrolls in a n MA Plan that has integrated PDP coverage? -
ANSWER-The consumer will be automatically disenrolled from their stand-alone PDP
upon enrollment in the MA Plan has integrated prescription drug coverage.
3. What is Medicare Part D? - ANSWER-A voluntary program, offered by private insurance
companies that are contracted with the federal government, that provide prescription
drug coverage for an additional monthly plan premium.
4. Which of the following statement is true about eligibility requirement for stand alone
Medicare prescription drug plans? - ANSWER-A consumer must be entitled to Medicare
Part A/ or enrolled in Medicare Part B
5. Aside from a Medicare Advantage Plan or other health plan that includes prescription
drug coverage, how else could a Medicare-eligible consumer get Part D PDP ? - ANSWER-
They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP)
6. In what order do they four prescription drug coverage stages occur? - ANSWER-
Deductible, Initial coverage, coverage gap, catastrophic coverage
7. Step Therapy, prior authorization, quantity limit 7-day limit, dispensing limit and limited
access are all examples of what? - ANSWER-
8. Which of the following best describes the Late Enrollment Penalty (LEP)? - ANSWER-The
amount added to the member's monthly plan premium if they did not enroll in a
Medicare advantage plan with part d benefits or stand alone PDP when they are first
eligible Medicare Part and B or went without creditable coverage for 63 days or more
days
9. Through which means if financial assistance offered to a consumer who qualifies for a LIS
for their parts of Medicare part D costs? - ANSWER-Through subsidies such as lower or
no monthly plan premiums and lower or no copayments
10. Which of the following list drug tiers from least expensive cost share to most expensive
cost shares - ANSWER-
11. In states where Medicare Supplements Insurance underwriting criteria can apply, all of
the following underwriting criteria apply EXCEPT: - ANSWER-
Complete Solutions
1. Which statement is true about the Medicare Advantage (MA) Out- of pocket Maximum?
- ANSWER-All MA plans have an Out- of Pocket maximum to help limit the member's out
of pocket cost for Medicare-covered services.
2. A consumer currently has Original Medicare and is enrolled in a stand alone PDP. What
will happen if the consumer enrolls in a n MA Plan that has integrated PDP coverage? -
ANSWER-The consumer will be automatically disenrolled from their stand-alone PDP
upon enrollment in the MA Plan has integrated prescription drug coverage.
3. What is Medicare Part D? - ANSWER-A voluntary program, offered by private insurance
companies that are contracted with the federal government, that provide prescription
drug coverage for an additional monthly plan premium.
4. Which of the following statement is true about eligibility requirement for stand alone
Medicare prescription drug plans? - ANSWER-A consumer must be entitled to Medicare
Part A/ or enrolled in Medicare Part B
5. Aside from a Medicare Advantage Plan or other health plan that includes prescription
drug coverage, how else could a Medicare-eligible consumer get Part D PDP ? - ANSWER-
They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP)
6. In what order do they four prescription drug coverage stages occur? - ANSWER-
Deductible, Initial coverage, coverage gap, catastrophic coverage
7. Step Therapy, prior authorization, quantity limit 7-day limit, dispensing limit and limited
access are all examples of what? - ANSWER-
8. Which of the following best describes the Late Enrollment Penalty (LEP)? - ANSWER-The
amount added to the member's monthly plan premium if they did not enroll in a
Medicare advantage plan with part d benefits or stand alone PDP when they are first
eligible Medicare Part and B or went without creditable coverage for 63 days or more
days
9. Through which means if financial assistance offered to a consumer who qualifies for a LIS
for their parts of Medicare part D costs? - ANSWER-Through subsidies such as lower or
no monthly plan premiums and lower or no copayments
10. Which of the following list drug tiers from least expensive cost share to most expensive
cost shares - ANSWER-
11. In states where Medicare Supplements Insurance underwriting criteria can apply, all of
the following underwriting criteria apply EXCEPT: - ANSWER-
