2023 UHC certifications with 100% questions and answers

Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? 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? 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? Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) 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? 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? 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? (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? (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? 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? 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? 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? 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) 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? 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? (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? Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: 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? 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. True Which of the following is NOT true of Medicare Supplement Insurance Plans? (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? 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) 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? 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? HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? 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? 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? They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? 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? 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 ______________. 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? 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? 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? Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? 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 Medicare Advantage or Prescription Drug plan? April 1 through October 31 Annual Election Period (AEP) is a time when. . . Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Mrs. Violet can access the Star Rating for a plan on M or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When the consumer consented to be contacted for sales activities and the permission has not yet expired. Which statement is true about discussing benefits with the consumer before an enrollment? The agent must accurately and completely disclose any benefits discussed. When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. Statement of Understanding What is Scope of Appointment? The agreement obtained from the consumer to that identifies the scope of products that can be discussed at a personal/individual marketing appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Melanie is currently enrolled in a Medicare Supplement Insurance Plan and a PDP. Assuming she has a valid election period, what would happen if she enrolled in an HMO MAPD plan? (INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. Medicare Advantage (MA) organization must disenroll a member from an MA plan in which situation? The member loses entitlement to either Medicare Part A or Part B. Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. In what product should agents enroll consumers? A product that is suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? AARP endorses UnitedHealthcare MA, PDP and Medicare Supplement plans. AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is _____________. Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare? Yes, if the consumer is enrolling in a Medicare Supplement Plan. How many status levels are in the Authorized to Offer Program? 2 According to AARP, there are how many individual AARP members? Nearly 37 million Which of the following statements about AARP are TRUE? (Select 2) The AARP motto is to serve, not be served. AARP advocates for the 50+ population in congress for legislation to lower medical costs. Which of the following is TRUE about the production requirement for the Authorized to Offer Elite status? Each calendar year, agents need to have at least 30 commission-eligible, accepted, and paid AARP Medicare Supplement Plan and/or Medicare Select Plan sales or retain a book of business of 150 or more active members. The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3) ... Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3) MA, PDP, Supplements Dual Special Needs Plans (D-SNP) are defined as which of the following: Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid. When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility? Upon notification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a D-SNP? Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) Which statement best describes a care management program that varies depending upon the level of the member's health risk? Support provided to C-SNP and D-SNP members that may have unique health care needs Select the statement that best describes a feature of D-SNPs. D-SNPs are network-based When selling D-SNPs, agents must: Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Which consumer may be a good candidate for a D-SNP? Anne, who does not pay a percentage of charges when she receives medical care The following is a characteristic of consumers for whom a C-SNP may be most appropriate: Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? Joy has a cardiovascular disorder, is enrolled in a C-SNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition. Which service will a C-SNP or D-SNP member in the high risk care management category receive? Case Management (telephonic, digital and/or face-to-face) according to individual needs Which statement is true about provider information on the Chronic Condition Verification Form? The provider indicated on the form does not have to be contracted with the plan. Which statement is true about the Medicaid program? Benefits vary from state to state. Which statement is true of D-SNP members? Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs. How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the D-SNP in which she is enrolled. What is her responsibility for cost sharing? All, such as premiums, deductibles, copayments, and coinsurance What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications? Marketing/sales event Which of the following does not describe a personal/individual marketing appointment? It needs to be reported to UnitedHealthcare prior to advertising and not less than 7 calendar days prior to the date of the event When conducting an event, agents should select a site that is compliant with the Americans with Disabilities Act (ADA). Which of the following is not an ADA requirement? Extra-wide sidewalks that accommodate wheelchairs Which of the following elements does not need to be entered on the NEW Event Request Form when reporting a new event? The event venue manager/contact person Jeff has an informal marketing/sales event scheduled this afternoon, but a consumer has requested an in-home appointment during that time. He would like to cancel or reschedule the event because he is certain to get an enrollment application at the appointment. Which of the statements below is correct about Jeff's event? Jeff is prohibited from canceling the event because it is within 1 business day and is not due to inclement weather. Jeff must hold his event or he could work with his manager to get a replacement to conduct the event. On October 1, Sam reported the formal marketing/sales event he has scheduled for 9 a.m. on November 19. Luckily, before he had flyers printed, he remembered he has an 8 a.m. dentist appointment November 19. Just to make sure he can get to his event on time, he advertises the event to start at 9:30 a.m. What event reporting infraction(s) might Sam incur? (INCORRECT) None, Sam reported the event prior to advertising and not less than 7 calendar days prior to the date of the event Marcus is planning an educational event and has decided to place an advertisement in the local paper. What must the advertisement include? A statement that makes it clear that the event is for educational purposes only. Which of the following food and beverage options may be provided at an educational event if the nominal retail value of the items when combined with other giveaways does not exceed $15 per person? (Select 2) Coffee, juice, fresh fruit, and pastries Boxed lunch with assorted non-alcoholic beverages If you conduct an educational event and invite a provider or vendor to be a part of the event, the provider/vendor must not do which of the following? Provide free health screenings such as blood pressure checks or hearing tests as a marketing activity Agent John Rogers is planning a formal marketing/sales event and has decided to place an advertisement in the local paper. What disclaimers must John include in the advertisement? "For accommodation of persons with special needs at sales meetings, call , TTY 711." Janine is conducting a marketing/sales event in a senior center cafeteria. The cafeteria generally provides a dinner meal from 5pm to 6pm. Can Janine conduct her marketing/sales meeting in the cafeteria between 5pm and 6pm? No, she can conduct an event that ends no later than 5pm or wait until after 6pm. Agent Rita Garcia must not do which of the following while conducting a marketing/sales event? State the plan she is presenting is the best plan on the market. At a formal marketing/sales event, an agent presented information about prescription drug coverage. Which statement is not accurate? Members and providers are not able to ask the plan for exceptions to any utilization management rules At an informal marketing/sales event, which of the following activities is not permitted? Approaching consumers as they pass by your booth/kiosk/table Agent Santana has developed a relationship with Dr. Westberry, a Primary Care Provider contracted with several Medicare Advantage Plans. Dr. Westberry is asked to attend a formal marketing/sales event conducted by Agent Santana. Which of Dr. Westberry's actions is non-compliant? Offers blood pressure screenings as consumers wait for the event to begin Which of the following best describes the purpose of event observation? An oversight activity where an individual evaluates an event as a means to ensure the information provided by the agent was accurate and compliant. Which of the following statements describes compliant activity during a formal marketing/sales event? Not one plan fits all Which of the following statements is true about conducting a formal marketing/sales event in a conference room inside a UnitedHealthcare MedicareStore? All rules relating to formal marketing/sales events apply including event reporting and providing a complete plan presentation. When must an agent inform the consumer of the availability of no-cost interpreter services? Whenever the agent is presenting a Medicare Advantage or Prescription Drug Plan.