UHC CERTIFICATION 2 LATEST VERSIONS 2024-2025 ACTUAL EXAM
200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
Her enrollment in Medicare Parts A and B is generally automatic if she meets all
eligibility requirements.
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits.
How does she enroll in Original Medicare?
When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not
automatically disenrolled from their MA Plan.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to
enroll in a Medicare Supplement Insurance Plan?
Original Medicare
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?
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 defines a Medicare Advantage (MA) Plan? (Select 2)
Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease
(ESRD)
Which of the following is NOT an eligibility requirement for enrollment in a Medicare
Advantage Plan?
Members must receive covered services from contracted network providers with limited
exceptions.
Which of the following statements is correct about HMO MA Plans?
(INCORRECT) Network-based MA plans have a provider network the member can use,
and some plans also cover certain services outside the network.
Which of the following is NOT a correct statement about in-network provider services?
(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.
, What is true about Medicare supplement open enrollment?
The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A
or B services.
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?
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 statements is true about a Medicare Supplement Insurance Plan member
who wants to enroll in an MA Plan?
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 best defines Medicare Part D?
To enroll, member must be in plans service area
Which of the following is a fact about Medicare Prescription Drug Plans?
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
What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
A deductible is the amount the member must pay for every prescription medication,
regardless of what stage they are in.
Which of the following statements does NOT correctly define prescription drug stages?
(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples
of UM rules
Which of these statements is NOT true about the drug utilization management (UM) rules?
Late Enrollment Penalty (LEP)
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?
Yes, through subsidies such as lower or no monthly plan premiums and lower or no
copayments
Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their
part of Medicare Part D costs?
200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
Her enrollment in Medicare Parts A and B is generally automatic if she meets all
eligibility requirements.
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits.
How does she enroll in Original Medicare?
When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not
automatically disenrolled from their MA Plan.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to
enroll in a Medicare Supplement Insurance Plan?
Original Medicare
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?
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 defines a Medicare Advantage (MA) Plan? (Select 2)
Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease
(ESRD)
Which of the following is NOT an eligibility requirement for enrollment in a Medicare
Advantage Plan?
Members must receive covered services from contracted network providers with limited
exceptions.
Which of the following statements is correct about HMO MA Plans?
(INCORRECT) Network-based MA plans have a provider network the member can use,
and some plans also cover certain services outside the network.
Which of the following is NOT a correct statement about in-network provider services?
(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.
, What is true about Medicare supplement open enrollment?
The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A
or B services.
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?
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 statements is true about a Medicare Supplement Insurance Plan member
who wants to enroll in an MA Plan?
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 best defines Medicare Part D?
To enroll, member must be in plans service area
Which of the following is a fact about Medicare Prescription Drug Plans?
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
What are two options for Medicare consumers to get Part D prescription drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
A deductible is the amount the member must pay for every prescription medication,
regardless of what stage they are in.
Which of the following statements does NOT correctly define prescription drug stages?
(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples
of UM rules
Which of these statements is NOT true about the drug utilization management (UM) rules?
Late Enrollment Penalty (LEP)
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?
Yes, through subsidies such as lower or no monthly plan premiums and lower or no
copayments
Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their
part of Medicare Part D costs?
