UHC 2024 AHIP - Medicare Basics
Assessment (Medicare Advantage [non-
SNP], Prescription Drug and Medicare
Supplement Plans) Exam Questions and
Answers
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security
benefits. How does she enroll in Original Medicare? - Answer-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? - Answer-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 a qualifying disability or being any
age with ESRD or ALS are each eligibility requirements for which program? - Answer-
Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - Answer--
An MA Plan is part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private
insurance companies.
-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? - Answer-Medicare Advantage
Which of the following is a correct statement about in-network provider services? -
Answer-HMO Plans cover only in-network services. In most cases, members pay the
full cost of any out-of-network services received, with a few important exceptions.
Which of the following is NOT a correct statement about in-network provider services? -
Answer-HMO-POS Plans only cover in-network services.
Which statement is true about Medicare Supplement Open Enrollment? - Answer-It is
the six-month period that starts the month the consumer is 65 or older and is enrolled in
Medicare Part B.
, Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum?
- Answer-All MA plans have an Out-of-Pocket Maximum to help limit the member's out-
of-pocket costs for Medicare-covered medical services.
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a
stand-alone PDP? - Answer-She would be disenrolled automatically from her MAPD
Plan.
What is Medicare Part D? - Answer-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 of the following best describes eligibility to enroll in a stand-alone Prescription
Drug Plan? - Answer-Entitled to Part A and/or enrolled in Part B and reside in the plan
service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-
eligible consumer get Part D prescription drug coverage? - Answer-They could enroll in
a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage.
Which of the following statements accurately describes a prescription drug stage? -
Answer-Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
Which of these statements is NOT true about the drug utilization management (UM)
rules? - Answer-If a medication has a UM rule, the member will not be able to get that
medication.
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? - Answer-Late Enrollment
Penalty (LEP)
What kind of financial assistance does a consumer receive who qualifies for Low
Income Subsidy? - Answer-Lower or no monthly plan premiums and lower or no
copayments
Which of the following lists drug tiers from least expensive cost share to most expensive
cost share? - Answer-Preferred Generics, Generics, Preferred Brand (and some higher-
cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty
In states where Medicare Supplement Insurance underwriting criteria can apply, all of
the following underwriting criteria apply EXCEPT: - Answer-Most consumers who are
Assessment (Medicare Advantage [non-
SNP], Prescription Drug and Medicare
Supplement Plans) Exam Questions and
Answers
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security
benefits. How does she enroll in Original Medicare? - Answer-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? - Answer-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 a qualifying disability or being any
age with ESRD or ALS are each eligibility requirements for which program? - Answer-
Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - Answer--
An MA Plan is part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private
insurance companies.
-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? - Answer-Medicare Advantage
Which of the following is a correct statement about in-network provider services? -
Answer-HMO Plans cover only in-network services. In most cases, members pay the
full cost of any out-of-network services received, with a few important exceptions.
Which of the following is NOT a correct statement about in-network provider services? -
Answer-HMO-POS Plans only cover in-network services.
Which statement is true about Medicare Supplement Open Enrollment? - Answer-It is
the six-month period that starts the month the consumer is 65 or older and is enrolled in
Medicare Part B.
, Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum?
- Answer-All MA plans have an Out-of-Pocket Maximum to help limit the member's out-
of-pocket costs for Medicare-covered medical services.
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a
stand-alone PDP? - Answer-She would be disenrolled automatically from her MAPD
Plan.
What is Medicare Part D? - Answer-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 of the following best describes eligibility to enroll in a stand-alone Prescription
Drug Plan? - Answer-Entitled to Part A and/or enrolled in Part B and reside in the plan
service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-
eligible consumer get Part D prescription drug coverage? - Answer-They could enroll in
a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage.
Which of the following statements accurately describes a prescription drug stage? -
Answer-Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
Which of these statements is NOT true about the drug utilization management (UM)
rules? - Answer-If a medication has a UM rule, the member will not be able to get that
medication.
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? - Answer-Late Enrollment
Penalty (LEP)
What kind of financial assistance does a consumer receive who qualifies for Low
Income Subsidy? - Answer-Lower or no monthly plan premiums and lower or no
copayments
Which of the following lists drug tiers from least expensive cost share to most expensive
cost share? - Answer-Preferred Generics, Generics, Preferred Brand (and some higher-
cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty
In states where Medicare Supplement Insurance underwriting criteria can apply, all of
the following underwriting criteria apply EXCEPT: - Answer-Most consumers who are
