Managed Care Exam 4 Questions and Answers Already Passed Latest Update 2025-2026
Medicare is provided without cost to the Medicare beneficiary. T/F - Answers False
Plans can receive bonus payments for high star quality ratings. The bonus payments can be
used to:
a. Provide additional benefits
b. reduce cost sharing
c. reduce enrollee premiums
d. all of the above - Answers D
Duel Eligible Special Needs Plans enroll individuals who are "dual eligible." Who are the dual
eligible? - Answers Individuals who are eligible for Medicare and Medicaid
MA plans must have a quality improvement program that measures performance under the
program and that includes:
a. CCIP
b. QIPs
c. Health Information Systems
d. all of the above - Answers D
CMS requires MA plans to have a quality improvement program to measure program
performance. T/F? - Answers True
The ACA is reducing enrollee cost sharing during the drug coverage gap. T/F? - Answers True
Most commercial managed care organizations avoid Medicaid because the payment rates are
so low. T/F? - Answers False
What of the following marketing and sales activities are allowed for Medicare Advantage or
managed Medicaid plans: - Answers None are allowed
Special Needs Plans (SNPs) are voluntary private MA plans that focus on only Medicare
beneficiaries with certain acute conditions. T/F - Answers False
Which of the following is not a measure in the Medicare Quality Bonus Program for Medicare
Advantage plans?
a. patient experience
b. intermediate outcomes
, c. reducing costs
d. health outcomes - Answers C.
Which of the following is NOT a medicare advantage plan?
a. medical savings account plans
b. private fee for service plans
c. small employer coverage plans
d. coordinated care plans - Answers C
For a state to use managed care for Medicaid beneficiaries, it must obtain a section 1115
waiver from HHS to use managed care and or contract with private organizations to manage
beneficiaries. T/F? - Answers True
Which of the following is not a type of Medicare Advantage Plans?
a. private fee for service
b. medical savings account
c. coordinated care plans
d. all of the above - Answers D
The ACA expanded Medicaid eligibility to 150% of the poverty level. T/F? - Answers False, 133
Which of the following Quality Programs requirements is similar to Disease Management (DM)
programs?
a. Quality improvement projects
b. health information system
c. Chronic Care Improvement Programs
d. None are accurate - Answers C
The majority of U.S. states have expanded Medicaid eligibility. - Answers True
Who of the following are eligible to be Medicare beneficiaries?
a. elderly
b. persons with end stage renal disease
c. disabled persons
Medicare is provided without cost to the Medicare beneficiary. T/F - Answers False
Plans can receive bonus payments for high star quality ratings. The bonus payments can be
used to:
a. Provide additional benefits
b. reduce cost sharing
c. reduce enrollee premiums
d. all of the above - Answers D
Duel Eligible Special Needs Plans enroll individuals who are "dual eligible." Who are the dual
eligible? - Answers Individuals who are eligible for Medicare and Medicaid
MA plans must have a quality improvement program that measures performance under the
program and that includes:
a. CCIP
b. QIPs
c. Health Information Systems
d. all of the above - Answers D
CMS requires MA plans to have a quality improvement program to measure program
performance. T/F? - Answers True
The ACA is reducing enrollee cost sharing during the drug coverage gap. T/F? - Answers True
Most commercial managed care organizations avoid Medicaid because the payment rates are
so low. T/F? - Answers False
What of the following marketing and sales activities are allowed for Medicare Advantage or
managed Medicaid plans: - Answers None are allowed
Special Needs Plans (SNPs) are voluntary private MA plans that focus on only Medicare
beneficiaries with certain acute conditions. T/F - Answers False
Which of the following is not a measure in the Medicare Quality Bonus Program for Medicare
Advantage plans?
a. patient experience
b. intermediate outcomes
, c. reducing costs
d. health outcomes - Answers C.
Which of the following is NOT a medicare advantage plan?
a. medical savings account plans
b. private fee for service plans
c. small employer coverage plans
d. coordinated care plans - Answers C
For a state to use managed care for Medicaid beneficiaries, it must obtain a section 1115
waiver from HHS to use managed care and or contract with private organizations to manage
beneficiaries. T/F? - Answers True
Which of the following is not a type of Medicare Advantage Plans?
a. private fee for service
b. medical savings account
c. coordinated care plans
d. all of the above - Answers D
The ACA expanded Medicaid eligibility to 150% of the poverty level. T/F? - Answers False, 133
Which of the following Quality Programs requirements is similar to Disease Management (DM)
programs?
a. Quality improvement projects
b. health information system
c. Chronic Care Improvement Programs
d. None are accurate - Answers C
The majority of U.S. states have expanded Medicaid eligibility. - Answers True
Who of the following are eligible to be Medicare beneficiaries?
a. elderly
b. persons with end stage renal disease
c. disabled persons
