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2023 UHC Certification Exam Q&As Verified Solutions (Latest Update 2023) Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? - Correct Answers ✅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? - Correct Answers ✅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 certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? - Correct Answers ✅Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) - Correct Answers ✅1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits.
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- MA Plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? - Correct Answers ✅Does not have any pre- existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? - Correct Answers ✅Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? - Correct Answers ✅(INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. What is true about Medicare supplement open enrollment? - Correct Answers ✅(INCORRECT) A consumer who waits to enroll in Medicare Part B
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or other private company approved by Medicare, which provides prescription drug coverage. Which of the following is a fact about Medicare Prescription Drug Plans? - Correct Answers ✅To enroll, member must be in plans service area What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) - Correct Answers ✅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 Which of the following statements does NOT correctly define prescription drug stages? - Correct Answers ✅A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in.
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Which of these statements is NOT true about the drug utilization management (UM) rules? - Correct Answers ✅(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM rules 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? - Correct Answers ✅Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? - Correct Answers ✅Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: - Correct Answers ✅A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists.
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Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - Correct Answers ✅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). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? - Correct Answers ✅Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? - Correct Answers ✅HMO, POS, PPO
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Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? - Correct Answers ✅She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? - Correct Answers ✅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 statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? - Correct Answers ✅A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - Correct Answers ✅They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? - Correct Answers ✅Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage
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Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? - Correct Answers ✅Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? - Correct Answers ✅Insured members have the freedom to choose any doctor who accepts Medicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? - Correct Answers ✅April 1 through October 31 Annual Election Period (AEP) is a time when... - Correct Answers ✅Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? - Correct Answers ✅Mrs.
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Violet can access the Star Rating for a plan on Medicare.gov or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - Correct Answers ✅When the consumer consented to be contacted for sales activities and the permission has not yet expired. Which statement is true about discussing benefits with the consumer before an enrollment? - Correct Answers ✅The agent must accurately and completely disclose any benefits discussed. When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? - Correct Answers ✅The consumer/member would not receive plan related correspondence intended for him/her. The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as
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Medicare Advantage (MA) organization must disenroll a member from an MA plan in which situation? - Correct Answers ✅The member loses entitlement to either Medicare Part A or Part B. Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? - Correct Answers ✅Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. In what product should agents enroll consumers? - Correct Answers ✅A product that is suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? - Correct Answers ✅Presented a plan before October 1
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Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? - Correct Answers ✅AARP endorses UnitedHealthcare MA, PDP and Medicare Supplement plans. AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is _____________. - Correct Answers ✅Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) - Correct Answers ✅Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information.
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AARP Medicare Supplement Plan and/or Medicare Select Plan sales or retain a book of business of 150 or more active members. The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3) - Correct Answers ✅ Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3) - Correct Answers ✅MA, PDP, Supplements Dual Special Needs Plans (D-SNP) are defined as which of the following: - Correct Answers ✅Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid. When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility? - Correct Answers ✅Upon notification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a D-SNP? - Correct Answers ✅Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)
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Which statement best describes a care management program that varies depending upon the level of the member's health risk? - Correct Answers ✅Support provided to C-SNP and D-SNP members that may have unique health care needs Select the statement that best describes a feature of D-SNPs. - Correct Answers ✅D-SNPs are network-based When selling D-SNPs, agents must: - Correct Answers ✅Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Which consumer may be a good candidate for a D-SNP? - Correct Answers ✅Anne, who does not pay a percentage of charges when she receives medical care The following is a characteristic of consumers for whom a C-SNP may be most appropriate: - Correct Answers ✅Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers
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Which statement is true of D-SNP members? - Correct Answers ✅Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs. How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? - Correct Answers ✅Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the D-SNP in which she is enrolled. What is her responsibility for cost sharing? - Correct Answers ✅All, such as premiums, deductibles, copayments, and coinsurance What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications? - Correct Answers ✅Marketing/sales event
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Which of the following does not describe a personal/individual marketing appointment? - Correct Answers ✅It needs to be reported to UnitedHealthcare prior to advertising and not less than 7 calendar days prior to the date of the event When conducting an event, agents should select a site that is compliant with the Americans with Disabilities Act (ADA). Which of the following is not an ADA requirement? - Correct Answers ✅Extra-wide sidewalks that accommodate wheelchairs Which of the following elements does not need to be entered on the NEW Event Request Form when reporting a new event? - Correct Answers ✅The event venue manager/contact person Jeff has an informal marketing/sales event scheduled this afternoon, but a consumer has requested an in-home appointment during that time. He would like to cancel or reschedule the event because he is certain to get an enrollment application at the appointment. Which of the statements below is correct about Jeff's event? - Correct Answers ✅Jeff is prohibited from canceling the event because it is within 1 business day and is not due to
