2023 UHC certifications 94 QUESTIONS WITH COMPLETE SOLUTIONS

Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct 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? Correct 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 certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? Correct Answer: Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) Correct Answer: 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits. 2. MA Plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? Correct Answer: Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? Correct Answer: Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? Correct Answer: (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. What is true about Medicare supplement open enrollment? Correct Answer: (INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement Insurance Plan. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? Correct Answer: The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. 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 must cancel their Medicare Supplement Insurance policy according to their carrier's rules. Which of the following best defines Medicare Part D? Correct Answer: It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. Which of the following is a fact about Medicare Prescription Drug Plans? Correct Answer: To enroll, member must be in plans service area What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) Correct Answer: Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage Which of the following statements does NOT correctly define prescription drug stages? Correct Answer: A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. Which of these statements is NOT true about the drug utilization management (UM) rules? Correct Answer: (INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM rules 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? Correct Answer: Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Correct Answer: Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: Correct Answer: A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? Correct Answer: Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. Correct Answer: True Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answer: (INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. Which of the following consumers are eligible for Medicare if other eligibility requirements are met? Correct Answer: Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) Correct Answer: 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). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? Correct Answer: Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? Correct Answer: HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? Correct Answer: She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? Correct 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 statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? Correct Answer: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B 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 prescription drug coverage? Correct Answer: They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? Correct Answer: Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? Correct Answer: Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) 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 ______________. Correct Answer: 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Correct Answer: Through subsidies such as lower or no monthly plan premiums and lower or no copayments Which of the following lists drug tiers from least expensive cost share to most expensive cost share? Correct Answer: Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? Correct Answer: Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? Correct Answer: Insured members have the freedom to choose any doctor who accepts Medicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a M