UHC 2021 Medicare Basics Test Questions And
Answers Graded A
A consumer currently has original Medicare and is enrolled in a standalone prescription drug plan
what will happen if the consumer enrolls in an MA plan that has integrated prescription drug coverage
Correct Answer: the consumer will be automatically disembroiled from the standalone PDP upon in
Roman in the MA plan that has integrated prescription drug coverage
Aside from a standalone Medicare prescription drug plan how else could a Medicare eligible
consumer get Part D prescription drug coverage Correct Answer: they can enroll in a Medicare
Advantage plan or other Medicare health plan that includes prescription drug coverage
Which of the following statements is not true about the coverage gap Correct Answer: all members
reach the coverage gap
Which of these statements is true about the drug utilization management UN rules Correct Answer:
prior authorization quantity limit and step therapy are some examples of the coverage rules
How does a consumer who qualifies for low income subsidy receive financial assistance through their
part of Medicare Part D costs Correct Answer: through subsidies such as lower or no monthly plan
premiums an lower or no copayments
Which of the following list drug tiers from least expensive cost share to most expensive cost share
Correct Answer: preferred generics preferred brand no preferred drug specialty
Which of the following is true about Medicare supplement insurance plans Correct Answer: plan
benefit amounts automatically update when Medicare changes cost sharing amounts such as
deductibles coinsurance and copayments
Which definition best describes Medicare Part A Correct Answer: the part of Medicare that helps with
the cost of inpatient hospital stays it also helps with Hospice care and some skilled care for
homebound
Which statement is true about members of a Medicare Advantage plan who wants to enroll in a
Medicare supplement insurance plan Correct Answer: the consumer must be in a valid MA election or
disenrollment?
Who is eligible for Medicare Correct Answer: consumers age 65 or older consumers under 65 years
of age with certain disabilities and consumers of all ages with ESRD or a LS
Which of the following defines a Medicare Advantage plan select two Correct Answer: MA plans
provide Medicare hospital and medical insurance and often include Medicare prescription drug
coverage
MA plans must provide benefits equivalent to original Medicare and most plans also offer additional
benefits
, To be eligible for this plan type consumers must meet the following requirements entitled to Medicare
Part A and enrolled in Part B reside in the planned service area which plan is described Correct
Answer: Medicare Advantage
Which type of MA plan is an HMO plan that also covers some benefits out of network generally at a
higher cost Correct Answer: point of service POS plan
When is Marys Medicare supplement open enrollment period if she turns 65 on September 23rd 2019
and her Medicare Part B effective date is September 1st 2019 Correct Answer: September 2019
through February 2020
A consumer with original Medicare might be interested in an MA plan because Correct Answer: MA
plans typically provide additional coverage beyond original Medicare and often have established
copayments for some benefits
Which of the following statements is true about a Medicare supplement insurance plan member who
wants to enroll in an MA plan Correct Answer: Medicare supplement insurance cannot be used in
conjunction with an MA plan therefore after receiving confirmation of enrollment into the MA plan the
member should submit to their Medicare supplement insurance carrier a written request to cancel
his/her policy
Which of the following statements does not correctly define prescription drug stages Correct Answer:
a deductible and the amount the member must pay for every prescription medication regardless of
what stage they are in
A consumer may have to pay a late enrollment penalty if they did not enroll in a Medicare Advantage
plan with the Part D benefits or stand alone prescription drug plan when they were first eligible for
Medicare parts A and or Part B or win without credible prescription drug coverage for Correct Answer:
63 continuous days or more
Being 65 or older being under 65 years of age with certain disabilities for more than 20 four months
and being any age with E SRD or LS or each eligibility requirements for which program Correct
Answer: original Medicare
Which of the following defines a medical advantage MA plan select two Correct Answer: MA plans or
health plan options approved by Medicare and offered by the Centers for Medicare and Medicaid
Services CMS
MA plans provide Medicare hospital and medical insurance and often include Medicare prescription
drug coverage
Member Doug enrolled in a health maintenance organization HMO MA plan he saw an out of network
doctor and received a bill for the entire cost of the visit Doug called Medicare to complain and stated
that he was never told about these types of costs what should the agent and explain better to Doug
when he was enrolled in the plan select three Correct Answer: that dog must receive coverage
services from contract in network providers
That in most cases Doug will pay the entire cost of the service if he sees an out of network provider
That exceptions to the provider network requirement are emergency visits urgent care and rental
dialysis services which can be obtained from out of network providers
Answers Graded A
A consumer currently has original Medicare and is enrolled in a standalone prescription drug plan
what will happen if the consumer enrolls in an MA plan that has integrated prescription drug coverage
Correct Answer: the consumer will be automatically disembroiled from the standalone PDP upon in
Roman in the MA plan that has integrated prescription drug coverage
Aside from a standalone Medicare prescription drug plan how else could a Medicare eligible
consumer get Part D prescription drug coverage Correct Answer: they can enroll in a Medicare
Advantage plan or other Medicare health plan that includes prescription drug coverage
Which of the following statements is not true about the coverage gap Correct Answer: all members
reach the coverage gap
Which of these statements is true about the drug utilization management UN rules Correct Answer:
prior authorization quantity limit and step therapy are some examples of the coverage rules
How does a consumer who qualifies for low income subsidy receive financial assistance through their
part of Medicare Part D costs Correct Answer: through subsidies such as lower or no monthly plan
premiums an lower or no copayments
Which of the following list drug tiers from least expensive cost share to most expensive cost share
Correct Answer: preferred generics preferred brand no preferred drug specialty
Which of the following is true about Medicare supplement insurance plans Correct Answer: plan
benefit amounts automatically update when Medicare changes cost sharing amounts such as
deductibles coinsurance and copayments
Which definition best describes Medicare Part A Correct Answer: the part of Medicare that helps with
the cost of inpatient hospital stays it also helps with Hospice care and some skilled care for
homebound
Which statement is true about members of a Medicare Advantage plan who wants to enroll in a
Medicare supplement insurance plan Correct Answer: the consumer must be in a valid MA election or
disenrollment?
Who is eligible for Medicare Correct Answer: consumers age 65 or older consumers under 65 years
of age with certain disabilities and consumers of all ages with ESRD or a LS
Which of the following defines a Medicare Advantage plan select two Correct Answer: MA plans
provide Medicare hospital and medical insurance and often include Medicare prescription drug
coverage
MA plans must provide benefits equivalent to original Medicare and most plans also offer additional
benefits
, To be eligible for this plan type consumers must meet the following requirements entitled to Medicare
Part A and enrolled in Part B reside in the planned service area which plan is described Correct
Answer: Medicare Advantage
Which type of MA plan is an HMO plan that also covers some benefits out of network generally at a
higher cost Correct Answer: point of service POS plan
When is Marys Medicare supplement open enrollment period if she turns 65 on September 23rd 2019
and her Medicare Part B effective date is September 1st 2019 Correct Answer: September 2019
through February 2020
A consumer with original Medicare might be interested in an MA plan because Correct Answer: MA
plans typically provide additional coverage beyond original Medicare and often have established
copayments for some benefits
Which of the following statements is true about a Medicare supplement insurance plan member who
wants to enroll in an MA plan Correct Answer: Medicare supplement insurance cannot be used in
conjunction with an MA plan therefore after receiving confirmation of enrollment into the MA plan the
member should submit to their Medicare supplement insurance carrier a written request to cancel
his/her policy
Which of the following statements does not correctly define prescription drug stages Correct Answer:
a deductible and the amount the member must pay for every prescription medication regardless of
what stage they are in
A consumer may have to pay a late enrollment penalty if they did not enroll in a Medicare Advantage
plan with the Part D benefits or stand alone prescription drug plan when they were first eligible for
Medicare parts A and or Part B or win without credible prescription drug coverage for Correct Answer:
63 continuous days or more
Being 65 or older being under 65 years of age with certain disabilities for more than 20 four months
and being any age with E SRD or LS or each eligibility requirements for which program Correct
Answer: original Medicare
Which of the following defines a medical advantage MA plan select two Correct Answer: MA plans or
health plan options approved by Medicare and offered by the Centers for Medicare and Medicaid
Services CMS
MA plans provide Medicare hospital and medical insurance and often include Medicare prescription
drug coverage
Member Doug enrolled in a health maintenance organization HMO MA plan he saw an out of network
doctor and received a bill for the entire cost of the visit Doug called Medicare to complain and stated
that he was never told about these types of costs what should the agent and explain better to Doug
when he was enrolled in the plan select three Correct Answer: that dog must receive coverage
services from contract in network providers
That in most cases Doug will pay the entire cost of the service if he sees an out of network provider
That exceptions to the provider network requirement are emergency visits urgent care and rental
dialysis services which can be obtained from out of network providers
