UHC certification exam 2023/ 157
Questions and Solved Answers.
Medicare - -Federal health insurance program
-Medicare is administered by whom? - -CMS ( Centers for medicare and medicaid
services)
-Parts A & B of medicare are - -federal health insurance program referred to as original
medicare
-Part A? - -Hospital insurance
-Part B? - -Medical insurance
-What doesnt medicare cover? - -routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
-Part C? - -Medicare Advantage Plans
-MA covers? - -Part A &B coverage, and some part D coverage
-MA plans are not? - -Medicare supplement insurance plans
-What offers lower monthly premiums MADP or supplement? - -MADP
-do MAP's have a annual maximum OOP maximum that limits the amount of money a
member must spend every year for covered services? - -YES
-MA plans integrate what type of additonal coverage? - -part D prescription drug
coverage
-If a customer wants to keep their stand alone prescription drug plan, what may the
customer want to enroll in? - -MA-only PFFS plan
-What is a stand alone drug plan called? - -PDP
-WHat is PFFS? - -Private Fee for Service (PFFS) - Plans that allow you to go to any
doctor or hospital that accepts their terms
-If a customer lives in a rural area, what type of plan may they want because it gives
them freedom to access doctors that may not be in their network? - -PFFS plan
-Do HMO's require referals? - -Yes
, -Do PPO's require a referal? - -No
-When a member enrolls in a MA plan, they receive their coverage from medicare or the
MA plan? - -MA plan
-When a customer is enrolled in a MA plan, they must continue paying their premiums
for what other plan? - -Part B
-MA plans have a maxium annual limit on OOP costs called a? - -MOOP amount
( Maxium out of pocket)
-When a member is enrolled in a MA plan, they are automatically disenrolled from any
other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new
plans_____? - -effective date
-An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - -Stand alone PDP
-If a member enrolls in a MA plan, what must the member do? - -Cancel in writing
their medicare supplement insurance policy with the carrier after their request to enroll
in MA plan has been approved.
-Medicare supplement insurance policies cannot be used in conjunction with what type
of plan? - -MA plan
-A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - -original medicare.
-A medicare supplement insurance plan does NOT pay the cost-sharing of what type of
plan? - -MA plan
-when a client enrolls in a MA plan, will it automatically terminate their MA plan? - -
NO
-Can a customer call to terminate their Med Sup plan? - -no it must be done in writing
-What are the different types of MA plans? - -HMO, POS, PPO, RPPO, PFFS, SNP, and
MSA
-For an HMO, they customer must us IN network providers, what are the exceptions to
their rule? - -Emergencies, Urgent care, and renal dialysis services.
-In a HMO plan, does a member have to choose a PCP? and do they require referrals to
see a specialist? - -Yes
-In a POS plan, does a member need a referral from their PCP to see a specialist? - -yes
Questions and Solved Answers.
Medicare - -Federal health insurance program
-Medicare is administered by whom? - -CMS ( Centers for medicare and medicaid
services)
-Parts A & B of medicare are - -federal health insurance program referred to as original
medicare
-Part A? - -Hospital insurance
-Part B? - -Medical insurance
-What doesnt medicare cover? - -routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
-Part C? - -Medicare Advantage Plans
-MA covers? - -Part A &B coverage, and some part D coverage
-MA plans are not? - -Medicare supplement insurance plans
-What offers lower monthly premiums MADP or supplement? - -MADP
-do MAP's have a annual maximum OOP maximum that limits the amount of money a
member must spend every year for covered services? - -YES
-MA plans integrate what type of additonal coverage? - -part D prescription drug
coverage
-If a customer wants to keep their stand alone prescription drug plan, what may the
customer want to enroll in? - -MA-only PFFS plan
-What is a stand alone drug plan called? - -PDP
-WHat is PFFS? - -Private Fee for Service (PFFS) - Plans that allow you to go to any
doctor or hospital that accepts their terms
-If a customer lives in a rural area, what type of plan may they want because it gives
them freedom to access doctors that may not be in their network? - -PFFS plan
-Do HMO's require referals? - -Yes
, -Do PPO's require a referal? - -No
-When a member enrolls in a MA plan, they receive their coverage from medicare or the
MA plan? - -MA plan
-When a customer is enrolled in a MA plan, they must continue paying their premiums
for what other plan? - -Part B
-MA plans have a maxium annual limit on OOP costs called a? - -MOOP amount
( Maxium out of pocket)
-When a member is enrolled in a MA plan, they are automatically disenrolled from any
other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new
plans_____? - -effective date
-An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - -Stand alone PDP
-If a member enrolls in a MA plan, what must the member do? - -Cancel in writing
their medicare supplement insurance policy with the carrier after their request to enroll
in MA plan has been approved.
-Medicare supplement insurance policies cannot be used in conjunction with what type
of plan? - -MA plan
-A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - -original medicare.
-A medicare supplement insurance plan does NOT pay the cost-sharing of what type of
plan? - -MA plan
-when a client enrolls in a MA plan, will it automatically terminate their MA plan? - -
NO
-Can a customer call to terminate their Med Sup plan? - -no it must be done in writing
-What are the different types of MA plans? - -HMO, POS, PPO, RPPO, PFFS, SNP, and
MSA
-For an HMO, they customer must us IN network providers, what are the exceptions to
their rule? - -Emergencies, Urgent care, and renal dialysis services.
-In a HMO plan, does a member have to choose a PCP? and do they require referrals to
see a specialist? - -Yes
-In a POS plan, does a member need a referral from their PCP to see a specialist? - -yes
