UHC Certification(50 QUESTIONS) WITH COMPLETE SOLUTIONS
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare
helps cover the costs of his inpatient hospital stay? Correct Answer: Part A
Correct Answer: The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? 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? Correct Answer: MA Plans
are health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must
she meet? (Select the two answers that apply.) Correct Answer: Not have End Stage Renal
Disease (permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization)
MA Plan? (Select 3) Correct Answer:
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
Which is true about Medicare Supplement Open Enrollment? Correct Answer: By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and
enrolled in Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? Correct Answer: The
OOP maximum is a feature that limits the amount of money a consumer will have to spend on
Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug
Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescription drug coverage? Correct Answer: The consumer will be automatically disenrolled
from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug
coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescription drug coverage describes which of the
following: Correct Answer: Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare
Prescription Drug Plans? Correct Answer: A consumer must be entitled to Medicare Part A
and/or enrolled in Medicare Part B
, What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2) Correct Answer:
Which of the following statements is not true about the Coverage Gap? Correct Answer: All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) Correct
Answer:
Which of the following best describes the Late Enrollment Penalty (LEP)? Correct 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 prescription drug plan when they were first
eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for
63 continuous days or more.
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
Medications that are covered in a Plan's formulary have various levels of associated member
cost-sharing (copayments or coinsurance). What are these drug levels called? Correct Answer:
Drug tiers
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the
following underwriting criteria apply EXCEPT: Correct Answer: Consumers may be
underwritten to determine their acceptance and, if applicable, their rate.
The new MACRA legislation, 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:
Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such
as deductibles, coinsurance and copayments. NOT
Which definition best describes Medicare Part A?
The part of Medicare that is a voluntary program offered by private insurance companies that
provides prescription drug coverage for an additional monthly premium.
The part of Medicare that offers combined medical and prescription drug coverage.
The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with
hospice care and some skilled care for the homebound.
The part of Medicare that helps with the cost of medically necessary doctor visits and other
medical services, including outpatient care at hospitals and clinics, laboratory tests, some
diagnostic screenings. 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 the homebound.
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare
helps cover the costs of his inpatient hospital stay? Correct Answer: Part A
Correct Answer: The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? 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? Correct Answer: MA Plans
are health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must
she meet? (Select the two answers that apply.) Correct Answer: Not have End Stage Renal
Disease (permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization)
MA Plan? (Select 3) Correct Answer:
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
Which is true about Medicare Supplement Open Enrollment? Correct Answer: By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and
enrolled in Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? Correct Answer: The
OOP maximum is a feature that limits the amount of money a consumer will have to spend on
Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug
Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescription drug coverage? Correct Answer: The consumer will be automatically disenrolled
from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug
coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescription drug coverage describes which of the
following: Correct Answer: Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare
Prescription Drug Plans? Correct Answer: A consumer must be entitled to Medicare Part A
and/or enrolled in Medicare Part B
, What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2) Correct Answer:
Which of the following statements is not true about the Coverage Gap? Correct Answer: All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) Correct
Answer:
Which of the following best describes the Late Enrollment Penalty (LEP)? Correct 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 prescription drug plan when they were first
eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for
63 continuous days or more.
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
Medications that are covered in a Plan's formulary have various levels of associated member
cost-sharing (copayments or coinsurance). What are these drug levels called? Correct Answer:
Drug tiers
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the
following underwriting criteria apply EXCEPT: Correct Answer: Consumers may be
underwritten to determine their acceptance and, if applicable, their rate.
The new MACRA legislation, 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:
Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such
as deductibles, coinsurance and copayments. NOT
Which definition best describes Medicare Part A?
The part of Medicare that is a voluntary program offered by private insurance companies that
provides prescription drug coverage for an additional monthly premium.
The part of Medicare that offers combined medical and prescription drug coverage.
The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with
hospice care and some skilled care for the homebound.
The part of Medicare that helps with the cost of medically necessary doctor visits and other
medical services, including outpatient care at hospitals and clinics, laboratory tests, some
diagnostic screenings. 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 the homebound.
