UHC CERTIFICATION 2 LATEST VERSIONS ACTUAL EXAM 200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)

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. - CORRECT ANSWER 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. -
CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER
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) - CORRECT ANSWER 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. - CORRECT ANSWER 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. - CORRECT ANSWER 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. - CORRECT ANSWER 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. - CORRECT ANSWER
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. - CORRECT ANSWER 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. - CORRECT ANSWER Which of
the following best defines Medicare Part D?


To enroll, member must be in plans service area - CORRECT
ANSWER 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 - CORRECT ANSWER 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. - CORRECT
ANSWER 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 - CORRECT ANSWER Which of these
statements is NOT true about the drug utilization management (UM)
rules?


Late Enrollment Penalty (LEP) - CORRECT ANSWER 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 - CORRECT ANSWER Can a consumer who
qualifies for Low Income Subsidy receive financial assistance for their
part of Medicare Part D costs?


A list of medications covered within the benefit plan, based on CMS
guidelines and developed in collaboration with physicians and
pharmacists. - CORRECT ANSWER Formulary is defined as:


Underwriting is required if the consumer is not in their Medicare
Supplement Open Enrollment period or does not meet Guaranteed Issue
criteria. - CORRECT ANSWER Which of the following is true about
Medicare Supplement Insurance underwriting criteria in states where
underwriting applies?