UHC 2026 AHIP - Medicare Basics Assessment (Medicare Advantage [non-
SNP], Prescription Drug and Medicare Supplement Plans)
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does
she enroll in Original Medicare? - (answer)Her enrollment in Medicare Parts A and B is generally
automatic if she meets all eligibility requirements.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a
Medicare Supplement Insurance Plan? - (answer)When a consumer enrolls in a Medicare Supplement
Insurance Plan, they are not automatically disenrolled from their MA Plan.
Being 65 or older, being under 65 years of age with a qualifying disability or being any age with ESRD or
ALS are each eligibility requirements for which program? - (answer)Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - (answer)-An MA Plan is
part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often
includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be entitled to
Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being
described? - (answer)Medicare Advantage
Which of the following is a correct statement about in-network provider services? - (answer)HMO Plans
cover only in-network services. In most cases, members pay the full cost of any out-of-network services
received, with a few important exceptions.
Which of the following is NOT a correct statement about in-network provider services? - (answer)HMO-
POS Plans only cover in-network services.
Which statement is true about Medicare Supplement Open Enrollment? - (answer)It is the six-month
period that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.
, UHC 2026 AHIP - Medicare Basics Assessment (Medicare Advantage [non-
SNP], Prescription Drug and Medicare Supplement Plans)
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 costs for Medicare-
covered medical services.
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? -
(answer)She would be disenrolled automatically from her MAPD Plan.
What is Medicare Part D? - (answer)A voluntary program, offered by private insurance companies that
are contracted with the federal government, that provides prescription drug coverage for an additional
monthly plan premium.
Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug Plan? -
(answer)Entitled to Part A and/or enrolled in Part B and reside in the plan service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer
get Part D prescription drug coverage? - (answer)They could enroll in a Medicare Advantage Plan or
other Medicare health plan that includes prescription drug coverage.
Which of the following statements accurately describes a prescription drug stage? - (answer)Starting in
2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs for the
remainder of the plan year.
Which of these statements is NOT true about the drug utilization management (UM) rules? - (answer)If a
medication has a UM rule, the member will not be able to get that medication.
What is 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 prescription drug plan when they were first eligible
for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more
continuous days? - (answer)Late Enrollment Penalty (LEP)
What kind of financial assistance does a consumer receive who qualifies for Low Income Subsidy? -
(answer)Lower or no monthly plan premiums and lower or no copayments
SNP], Prescription Drug and Medicare Supplement Plans)
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does
she enroll in Original Medicare? - (answer)Her enrollment in Medicare Parts A and B is generally
automatic if she meets all eligibility requirements.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a
Medicare Supplement Insurance Plan? - (answer)When a consumer enrolls in a Medicare Supplement
Insurance Plan, they are not automatically disenrolled from their MA Plan.
Being 65 or older, being under 65 years of age with a qualifying disability or being any age with ESRD or
ALS are each eligibility requirements for which program? - (answer)Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - (answer)-An MA Plan is
part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often
includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be entitled to
Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being
described? - (answer)Medicare Advantage
Which of the following is a correct statement about in-network provider services? - (answer)HMO Plans
cover only in-network services. In most cases, members pay the full cost of any out-of-network services
received, with a few important exceptions.
Which of the following is NOT a correct statement about in-network provider services? - (answer)HMO-
POS Plans only cover in-network services.
Which statement is true about Medicare Supplement Open Enrollment? - (answer)It is the six-month
period that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.
, UHC 2026 AHIP - Medicare Basics Assessment (Medicare Advantage [non-
SNP], Prescription Drug and Medicare Supplement Plans)
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 costs for Medicare-
covered medical services.
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? -
(answer)She would be disenrolled automatically from her MAPD Plan.
What is Medicare Part D? - (answer)A voluntary program, offered by private insurance companies that
are contracted with the federal government, that provides prescription drug coverage for an additional
monthly plan premium.
Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug Plan? -
(answer)Entitled to Part A and/or enrolled in Part B and reside in the plan service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer
get Part D prescription drug coverage? - (answer)They could enroll in a Medicare Advantage Plan or
other Medicare health plan that includes prescription drug coverage.
Which of the following statements accurately describes a prescription drug stage? - (answer)Starting in
2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs for the
remainder of the plan year.
Which of these statements is NOT true about the drug utilization management (UM) rules? - (answer)If a
medication has a UM rule, the member will not be able to get that medication.
What is 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 prescription drug plan when they were first eligible
for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more
continuous days? - (answer)Late Enrollment Penalty (LEP)
What kind of financial assistance does a consumer receive who qualifies for Low Income Subsidy? -
(answer)Lower or no monthly plan premiums and lower or no copayments
