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2023 UHC certifications 94 QUESTIONS WITH
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Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct Answer: 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 Answer: 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 Answer: Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) Correct Answer: 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits.
- 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 Answer: 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 Answer: 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 Answer: (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 Answer: (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. 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? Correct Answer: The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? Correct Answer: 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 best defines Medicare Part D? Correct Answer: 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 is a fact about Medicare Prescription Drug Plans? Correct Answer: 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 Answer: 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
Which of these statements is NOT true about the drug utilization management (UM) rules? Correct Answer: (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 Answer: 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 Answer: Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: Correct Answer: A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? Correct Answer: Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. Correct Answer: True Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answer: (INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. Which of the following consumers are eligible for Medicare if other eligibility requirements are met? Correct Answer: Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) Correct Answer:
An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.
A consumer may have to pay a Late Enrollment Penalty (LEP) 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. Correct Answer: 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Correct Answer: Through subsidies such as lower or no monthly plan premiums and lower or no copayments Which of the following lists drug tiers from least expensive cost share to most expensive cost share? Correct Answer: Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty 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 Answer: Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? Correct Answer: 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 Answer: April 1 through October 31 Annual Election Period (AEP) is a time when... Correct Answer: 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 Answer: Mrs. 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 Answer: When the consumer consented to be contacted for sales activities and the permission has not yet expired.
prescription drug coverage, which will disenroll him from his PDP.
In what product should agents enroll consumers? Correct Answer: 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 Answer: Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? Correct Answer: 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 Answer: Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) Correct Answer: Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare? Correct Answer: Yes, if the consumer is enrolling in a Medicare Supplement Plan. How many status levels are in the Authorized to Offer Program? Correct Answer: 2 According to AARP, there are how many individual AARP members? Correct Answer: Nearly 37 million Which of the following statements about AARP are TRUE? (Select 2) Correct Answer: The AARP motto is to serve, not be served.
Which consumer may be a good candidate for a D-SNP? Correct Answer: 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 Answer: 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 On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? Correct Answer: Joy has a cardiovascular disorder, is enrolled in a C-SNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition. Which service will a C-SNP or D-SNP member in the high risk care management category receive? Correct Answer: Case Management (telephonic, digital and/or face-to-face) according to individual needs Which statement is true about provider information on the Chronic Condition Verification Form? Correct Answer: The provider indicated on the form does not have to be contracted with the plan. Which statement is true about the Medicaid program? Correct Answer: Benefits vary from state to state. Which statement is true of D-SNP members? Correct Answer: 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 Answer: 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 Answer: All,
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 Answer: Marketing/sales event Which of the following does not describe a personal/individual marketing appointment? Correct Answer: 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 Answer: 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 Answer: 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 Answer: Jeff is prohibited from canceling the event because it is within 1 business day and is not due to inclement weather. Jeff must hold his event or he could work with his manager to get a replacement to conduct the event. On October 1, Sam reported the formal marketing/sales event he has scheduled for 9 a.m. on November 19. Luckily, before he had flyers printed, he remembered he has an 8 a.m. dentist appointment November 19. Just to make sure he can get to his event on time, he advertises the event to start at 9:30 a.m. What event reporting infraction(s) might Sam incur? Correct Answer: (INCORRECT) None, Sam reported the event prior to advertising and not less than 7 calendar days prior to the date of the event Marcus is planning an educational event and has decided to place an advertisement in the local paper. What must the advertisement include? Correct Answer: A statement that makes it clear that the event is for educational purposes only. Which of the following food and beverage options may be provided at an educational event if
the nominal retail value of the items when combined with
Which of the following best describes the purpose of event observation? Correct Answer: An oversight activity where an individual evaluates an event as a means to ensure the information provided by the agent was accurate and compliant. Which of the following statements describes compliant activity during a formal marketing/sales event? Correct Answer: Not one plan fits all Which of the following statements is true about conducting a formal marketing/sales event in a conference room inside a UnitedHealthcare MedicareStore? Correct Answer: All rules relating to formal marketing/sales events apply including event reporting and providing a complete plan presentation. When must an agent inform the consumer of the availability of no-cost interpreter services? Correct Answer: Whenever the agent is presenting a Medicare Advantage or Prescription Drug Plan.
