UHC CERTIFICATION EXAM 2026 – PRACTICE
QUESTIONS & VERIFIED ANSWERS (A+ GUIDE)
Medicare
Federal health insurance program
What is the coverage gap for medicare prescription drug coverage?
Its a temporary limit on what the medicare prescription drug plan will cover
When a customer reaches the ____ They will pay 25% for most brand named drugs and 37%
for generic drugs
coverage gap
consumers with limited _____ may qualify for extra help from medicare to cover their part D
premiums and Part D related OOP costs
income and resources
TO qualify for low income subsidy on part D, the consumers income must be at or below
150% of the FPL ( federal poverty level)
when does approved extra help begin?
,the first day of the month the customer becomes eligible
how does a customer qualify for extra help?
they receive both medicare and medicaid benefits, receive SSI and meet a certain income,
and are a MSP participant( medicare savings program)
if a customer who automatically qualifies for extra help doesnt enroll in a prescription drug
plan, medicare may automatically enroll them in one so they will be able to use the_____?
extra help
What is creditable coverage?
its a prescription drug coverage that is expected to pay on average at least as much as
medicare's standard prescription drug coverage
What are some examples of creditable coverage?
drug plan from an employer, union, TRICARE, indian health service, or department of
veterans affairs
consumers with creditable coverage when they become eligible for medicare can generally
keep that coverage without paying a ____ if they decide to enroll in medicare prescription
drug coverage later?
penality
, The organization providing the prescription drug coverage MUST inform the consumer
annually if the prescription drug coverage is ________
creditable coverage
how many days does medicare allow before a customer accrues a penalty
63 days
if a customer accrues a late penalty for not accepting medicare before the 63 day limit, the
late enrollment penalty is added to what?
the monthly plan premium
What is the late enrollment penalty?
1% x 35.02(2018 NBBP or national base beneficiary premium) x # of months= penalty
Can the pharmacy used impact OOP costs for covered drugs?
yes. The customer should use a preferred or standard in network pharmacy
Under the part D benefit, drugs filled at an OON pharmacy are covered only when the
member is not able to use an in-network pharmacies for covered medications, generally at
a higher ________
OOP cost
QUESTIONS & VERIFIED ANSWERS (A+ GUIDE)
Medicare
Federal health insurance program
What is the coverage gap for medicare prescription drug coverage?
Its a temporary limit on what the medicare prescription drug plan will cover
When a customer reaches the ____ They will pay 25% for most brand named drugs and 37%
for generic drugs
coverage gap
consumers with limited _____ may qualify for extra help from medicare to cover their part D
premiums and Part D related OOP costs
income and resources
TO qualify for low income subsidy on part D, the consumers income must be at or below
150% of the FPL ( federal poverty level)
when does approved extra help begin?
,the first day of the month the customer becomes eligible
how does a customer qualify for extra help?
they receive both medicare and medicaid benefits, receive SSI and meet a certain income,
and are a MSP participant( medicare savings program)
if a customer who automatically qualifies for extra help doesnt enroll in a prescription drug
plan, medicare may automatically enroll them in one so they will be able to use the_____?
extra help
What is creditable coverage?
its a prescription drug coverage that is expected to pay on average at least as much as
medicare's standard prescription drug coverage
What are some examples of creditable coverage?
drug plan from an employer, union, TRICARE, indian health service, or department of
veterans affairs
consumers with creditable coverage when they become eligible for medicare can generally
keep that coverage without paying a ____ if they decide to enroll in medicare prescription
drug coverage later?
penality
, The organization providing the prescription drug coverage MUST inform the consumer
annually if the prescription drug coverage is ________
creditable coverage
how many days does medicare allow before a customer accrues a penalty
63 days
if a customer accrues a late penalty for not accepting medicare before the 63 day limit, the
late enrollment penalty is added to what?
the monthly plan premium
What is the late enrollment penalty?
1% x 35.02(2018 NBBP or national base beneficiary premium) x # of months= penalty
Can the pharmacy used impact OOP costs for covered drugs?
yes. The customer should use a preferred or standard in network pharmacy
Under the part D benefit, drugs filled at an OON pharmacy are covered only when the
member is not able to use an in-network pharmacies for covered medications, generally at
a higher ________
OOP cost
