UHC CERTIFICATION 2 LATEST VERSIONS ACTUAL EXAM
200 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+
Medicare - ANSWER: Federal health insurance program
Medicare is administered by whom? - ANSWER: CMS ( Centers for medicare and
medicaid services)
Parts A & B of medicare are - ANSWER: federal health insurance program referred to
as original medicare
Part A? - ANSWER: Hospital insurance
Part B? - ANSWER: Medical insurance
What doesnt medicare cover? - ANSWER: routine dental, eye care hearing
exam,deductibles, coinsurance and copayments
Part C? - ANSWER: Medicare Advantage Plans
MA covers? - ANSWER: Part A &B coverage, and some part D coverage
MA plans are not? - ANSWER: Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWER: 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? - ANSWER: YES
MA plans integrate what type of additonal coverage? - ANSWER: 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? - ANSWER: MA-only PFFS plan
What is a stand alone drug plan called? - ANSWER: PDP
WHat is PFFS? - ANSWER: 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? - ANSWER: PFFS
plan
, Do HMO's require referals? - ANSWER: Yes
Do PPO's require a referal? - ANSWER: No
When a member enrolls in a MA plan, they receive their coverage from medicare or
the MA plan? - ANSWER: MA plan
When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan? - ANSWER: Part B
MA plans have a maxium annual limit on OOP costs called a? - ANSWER: 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_____? - ANSWER: effective date
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - ANSWER: Stand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWER: 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? - ANSWER: MA plan
A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - ANSWER: original medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type
of plan? - ANSWER: MA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? -
ANSWER: NO
Can a customer call to terminate their Med Sup plan? - ANSWER: no it must be done
in writing
What are the different types of MA plans? - ANSWER: 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? - ANSWER: Emergencies, Urgent care, and renal dialysis services.
200 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+
Medicare - ANSWER: Federal health insurance program
Medicare is administered by whom? - ANSWER: CMS ( Centers for medicare and
medicaid services)
Parts A & B of medicare are - ANSWER: federal health insurance program referred to
as original medicare
Part A? - ANSWER: Hospital insurance
Part B? - ANSWER: Medical insurance
What doesnt medicare cover? - ANSWER: routine dental, eye care hearing
exam,deductibles, coinsurance and copayments
Part C? - ANSWER: Medicare Advantage Plans
MA covers? - ANSWER: Part A &B coverage, and some part D coverage
MA plans are not? - ANSWER: Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWER: 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? - ANSWER: YES
MA plans integrate what type of additonal coverage? - ANSWER: 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? - ANSWER: MA-only PFFS plan
What is a stand alone drug plan called? - ANSWER: PDP
WHat is PFFS? - ANSWER: 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? - ANSWER: PFFS
plan
, Do HMO's require referals? - ANSWER: Yes
Do PPO's require a referal? - ANSWER: No
When a member enrolls in a MA plan, they receive their coverage from medicare or
the MA plan? - ANSWER: MA plan
When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan? - ANSWER: Part B
MA plans have a maxium annual limit on OOP costs called a? - ANSWER: 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_____? - ANSWER: effective date
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - ANSWER: Stand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWER: 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? - ANSWER: MA plan
A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - ANSWER: original medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type
of plan? - ANSWER: MA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? -
ANSWER: NO
Can a customer call to terminate their Med Sup plan? - ANSWER: no it must be done
in writing
What are the different types of MA plans? - ANSWER: 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? - ANSWER: Emergencies, Urgent care, and renal dialysis services.
