UHC CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2026
1. Medicare-ANSWER- Federal health insurance program
2. Medicare is administered by whom?-ANSWER- CMS ( Centers for medicare and medicaid
services)
3. Parts A & B of medicare are-ANSWER- federal health insurance program referred to as
original medicare
4. Part A?-ANSWER- Hospital insurance
5. Part B?-ANSWER- Medical insurance
6. What doesnt medicare cover?-ANSWER- routine dental, eye care hearing exam,deductibles,
coinsurance and
copayments
7. Part C?-ANSWER- Medicare Advantage Plans
8. MA covers?-ANSWER- Part A &B coverage, and some part D coverage
9. MA plans are not?-ANSWER- Medicare supplement insurance plans
10. What offers lower monthly premiums MADP or supplement?-ANSWER- MADP
11. 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
12. MA plans integrate what type of additonal coverage?-ANSWER- part D prescription drug
coverage
13. 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
14. What is a stand alone drug plan called?-ANSWER- PDP
15. WHat is PFFS?-ANSWER- Private Fee for Service (PFFS) - Plans that allow you to go to any
doctor or hospital that accepts
their terms
,16. 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
17. Do HMO's require referals?-ANSWER- Yes
18. Do PPO's require a referal?-ANSWER- No
19. When a member enrolls in a MA plan, they receive their coverage from
medicare or the MA plan?-ANSWER- MA plan
20. When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan?-ANSWER- Part B
21. MA plans have a maxium annual limit on OOP costs called a?-ANSWER- MOOP amount (
Maxium out of pocket)
UHC certification
Study online at https-ANSWER-//quizlet.com/_ily0an
22. 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
23. An exception exisits for MA-only PFFS plans as a member can also be enrolled
in a what?-ANSWER- Stand alone PDP
24. 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.
25. Medicare supplement insurance policies cannot be used in conjunction with
what type of plan?-ANSWER- MA plan
26. A medicare supplement insurance plan helps to cover some of the OOP costs
associated with?-ANSWER- original medicare.
, 27. A medicare supplement insurance plan does NOT pay the cost-sharing of
what type of plan?-ANSWER- MA plan
28. when a client enrolls in a MA plan, will it automatically terminate their MA
plan?-ANSWER- NO
29. Can a customer call to terminate their Med Sup plan?-ANSWER- no it must be done in
writing
30. What are the different types of MA plans?-ANSWER- HMO, POS, PPO, RPPO, PFFS, SNP, and
MSA
31. 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.
32. In a HMO plan, does a member have to choose a PCP? and do they require
referrals to see a specialist?-ANSWER- Yes
33. In a POS plan, does a member need a referral from their PCP to see a
specialist?-ANSWER- yes
34. Can a member with a POS plan see a specialist?-ANSWER- Yes, but they may have to pay a
higher
cost, and there coverage limits
35. With a PFFS plan, can a member seek treatment from any medicare eligible
provider who agrees to accept the plans conditions and payment rates?-ANSWER- Yes
36. Does a PCP need to be selected with a PFFS plan?-ANSWER- No
37. What is the only plan to offer non-network PFFS plans?-ANSWER- UHC
38. What are SNP's for? ( Dual SNP)-ANSWER- People who have both medicare and Medicaid
39. Institutional SNP?-ANSWER- Nursing homes
40. Chronic condition SNP?-ANSWER- people who have certain chronic medical conditions
UHC certification
Study online at https-ANSWER-//quizlet.com/_ily0an
CORRECT ANSWERS 2026
1. Medicare-ANSWER- Federal health insurance program
2. Medicare is administered by whom?-ANSWER- CMS ( Centers for medicare and medicaid
services)
3. Parts A & B of medicare are-ANSWER- federal health insurance program referred to as
original medicare
4. Part A?-ANSWER- Hospital insurance
5. Part B?-ANSWER- Medical insurance
6. What doesnt medicare cover?-ANSWER- routine dental, eye care hearing exam,deductibles,
coinsurance and
copayments
7. Part C?-ANSWER- Medicare Advantage Plans
8. MA covers?-ANSWER- Part A &B coverage, and some part D coverage
9. MA plans are not?-ANSWER- Medicare supplement insurance plans
10. What offers lower monthly premiums MADP or supplement?-ANSWER- MADP
11. 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
12. MA plans integrate what type of additonal coverage?-ANSWER- part D prescription drug
coverage
13. 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
14. What is a stand alone drug plan called?-ANSWER- PDP
15. WHat is PFFS?-ANSWER- Private Fee for Service (PFFS) - Plans that allow you to go to any
doctor or hospital that accepts
their terms
,16. 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
17. Do HMO's require referals?-ANSWER- Yes
18. Do PPO's require a referal?-ANSWER- No
19. When a member enrolls in a MA plan, they receive their coverage from
medicare or the MA plan?-ANSWER- MA plan
20. When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan?-ANSWER- Part B
21. MA plans have a maxium annual limit on OOP costs called a?-ANSWER- MOOP amount (
Maxium out of pocket)
UHC certification
Study online at https-ANSWER-//quizlet.com/_ily0an
22. 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
23. An exception exisits for MA-only PFFS plans as a member can also be enrolled
in a what?-ANSWER- Stand alone PDP
24. 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.
25. Medicare supplement insurance policies cannot be used in conjunction with
what type of plan?-ANSWER- MA plan
26. A medicare supplement insurance plan helps to cover some of the OOP costs
associated with?-ANSWER- original medicare.
, 27. A medicare supplement insurance plan does NOT pay the cost-sharing of
what type of plan?-ANSWER- MA plan
28. when a client enrolls in a MA plan, will it automatically terminate their MA
plan?-ANSWER- NO
29. Can a customer call to terminate their Med Sup plan?-ANSWER- no it must be done in
writing
30. What are the different types of MA plans?-ANSWER- HMO, POS, PPO, RPPO, PFFS, SNP, and
MSA
31. 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.
32. In a HMO plan, does a member have to choose a PCP? and do they require
referrals to see a specialist?-ANSWER- Yes
33. In a POS plan, does a member need a referral from their PCP to see a
specialist?-ANSWER- yes
34. Can a member with a POS plan see a specialist?-ANSWER- Yes, but they may have to pay a
higher
cost, and there coverage limits
35. With a PFFS plan, can a member seek treatment from any medicare eligible
provider who agrees to accept the plans conditions and payment rates?-ANSWER- Yes
36. Does a PCP need to be selected with a PFFS plan?-ANSWER- No
37. What is the only plan to offer non-network PFFS plans?-ANSWER- UHC
38. What are SNP's for? ( Dual SNP)-ANSWER- People who have both medicare and Medicaid
39. Institutional SNP?-ANSWER- Nursing homes
40. Chronic condition SNP?-ANSWER- people who have certain chronic medical conditions
UHC certification
Study online at https-ANSWER-//quizlet.com/_ily0an
