UHC Certification Exam 2024 Questions and Answers
(Verified 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.
(Verified 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.
