UHC Medicare Basics Assessment-2024
In which two parts of Medicare is enrollment generally automatic for eligible consumers who are
receiving Social Security benefits, UNLESS they choose to delay their coverage? -CORRECT ANS-Parts A
and B
Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a
Medicare Supplement Insurance Plan? -CORRECT ANS-The consumer must be in a valid MA election or
disenrollment period.
Provided other eligibility requirements are met, who is eligible for Medicare? -CORRECT ANS-Consumers
age 65 or older, consumers under 65 years of age with a qualifying disability and consumers of all ages
with ESRD or ALS who are receiving Social Security Disability Insurance (SSDI) for ALS.
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) -CORRECT ANS--An MA Plan
is a health plan option approved by Medicare and offered by private insurance companies.
-An MA Plan is part of Medicare and is also called Part C.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often
includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be entitled to
Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being
described? -CORRECT ANS-Medicare Advantage
Which of the following statements is correct about HMO MA Plans? -CORRECT ANS-Members must
receive covered services from contracted network providers with limited exceptions.
Which of the following are MA Plans that focus on using network providers to maximize the benefits and
reduce out-of-network expenses? -CORRECT ANS-HMO, POS, PPO
When does Medicare Supplement Open Enrollment take place? -CORRECT ANS-During the first six
months a consumer is 65 or older and enrolled in Medicare Part B.
, What costs count toward the out-of-pocket maximum for Medicare Advantage (MA) Plans? -CORRECT
ANS-The Out-of-Pocket Maximum includes costs the member pays for any Medicare-covered Part A or B
services but does not include the cost of any plan premiums.
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 ANS-The consumer will be automatically disenrolled from their stand-alone PDP
upon enrollment in the MA Plan that has integrated prescription drug coverage
What is Medicare Part D? -CORRECT ANS-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 consumer is eligible for a stand-alone Medicare Prescription Drug Plan? -CORRECT ANS-Joseph,
who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area.
A consumer with only Part A residing in the plan's service area can enroll in which plan type to get Part D
coverage? -CORRECT ANS-A stand-alone Part D Plan.
Which of the following statements accurately describes a prescription drug stage? -CORRECT ANS-
Starting in 2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs
for the remainder of the plan year.
Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all
examples of what? -CORRECT ANS-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
______________. -CORRECT ANS-63 or more continuous days
How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of
Medicare Part D costs? -CORRECT ANS-Through subsidies such as lower or no monthly plan premiums
and lower or no copayments.
In which two parts of Medicare is enrollment generally automatic for eligible consumers who are
receiving Social Security benefits, UNLESS they choose to delay their coverage? -CORRECT ANS-Parts A
and B
Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a
Medicare Supplement Insurance Plan? -CORRECT ANS-The consumer must be in a valid MA election or
disenrollment period.
Provided other eligibility requirements are met, who is eligible for Medicare? -CORRECT ANS-Consumers
age 65 or older, consumers under 65 years of age with a qualifying disability and consumers of all ages
with ESRD or ALS who are receiving Social Security Disability Insurance (SSDI) for ALS.
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) -CORRECT ANS--An MA Plan
is a health plan option approved by Medicare and offered by private insurance companies.
-An MA Plan is part of Medicare and is also called Part C.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often
includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be entitled to
Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being
described? -CORRECT ANS-Medicare Advantage
Which of the following statements is correct about HMO MA Plans? -CORRECT ANS-Members must
receive covered services from contracted network providers with limited exceptions.
Which of the following are MA Plans that focus on using network providers to maximize the benefits and
reduce out-of-network expenses? -CORRECT ANS-HMO, POS, PPO
When does Medicare Supplement Open Enrollment take place? -CORRECT ANS-During the first six
months a consumer is 65 or older and enrolled in Medicare Part B.
, What costs count toward the out-of-pocket maximum for Medicare Advantage (MA) Plans? -CORRECT
ANS-The Out-of-Pocket Maximum includes costs the member pays for any Medicare-covered Part A or B
services but does not include the cost of any plan premiums.
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 ANS-The consumer will be automatically disenrolled from their stand-alone PDP
upon enrollment in the MA Plan that has integrated prescription drug coverage
What is Medicare Part D? -CORRECT ANS-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 consumer is eligible for a stand-alone Medicare Prescription Drug Plan? -CORRECT ANS-Joseph,
who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area.
A consumer with only Part A residing in the plan's service area can enroll in which plan type to get Part D
coverage? -CORRECT ANS-A stand-alone Part D Plan.
Which of the following statements accurately describes a prescription drug stage? -CORRECT ANS-
Starting in 2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs
for the remainder of the plan year.
Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all
examples of what? -CORRECT ANS-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
______________. -CORRECT ANS-63 or more continuous days
How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of
Medicare Part D costs? -CORRECT ANS-Through subsidies such as lower or no monthly plan premiums
and lower or no copayments.
