UHC certifications exams 2023/ 94
Questions and Answers / Graded A+
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
Questions and Answers / Graded A+
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
