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UHC Certification Exam ( 2024 /2025) | Actual Questions and Answers Latest
Updated 2024/2025 (Graded A+)
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare helps cover the costs of his inpatient hospital stay? - ✔✔Part A
- ✔✔The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - ✔✔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? - ✔✔MA Plans are health plan options approved by Medicare and offered by private insurance companies. Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she meet? (Select the two answers that apply.) - ✔✔Not have End Stage Renal Disease (permanent kidney failure)Reside in the plan's service area What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3) - ✔✔ Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? - ✔✔HMO, POS, PPO Which is true about Medicare Supplement Open Enrollment? - ✔✔By federal law, Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and enrolled in Medicare Part B. How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? - ✔✔The OOP maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug coverage? - ✔✔The consumer will be automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage A government program, offered only through a private insurance company or other private company approved by Medicare, that provides prescription drug coverage describes which of the following: - ✔✔Medicare Parts A and B Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? - ✔✔A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) - ✔✔ Which of the following statements is not true about the Coverage Gap? - ✔✔All members reach the Coverage Gap Which of the following options are drug utilization management (UM) rules? (Select 3) - ✔✔ Which of the following best describes the Late Enrollment Penalty (LEP)? - ✔✔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 continuous days or more. Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? - ✔✔Through subsidies such as lower or no monthly plan premiums and lower or no copayments Medications that are covered in a Plan's formulary have various levels of associated member cost- sharing (copayments or coinsurance). What are these drug levels called? - ✔✔Drug tiers
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? Medicaid Original Medicare Low Income Subsidy - ✔✔Original Medicare To be eligible for this plan type, consumers must meet the following requirements:- Entitled to Medicare Part A and enrolled in Part B- Reside in the plan's service areaWhich plan is being described? Medicare Advantage Prescription Drug Medicaid Original Medicare - ✔✔Medicare Advantage What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3) They must see contracted network providers in order to receive coverage under the plan. In most cases, they will pay the entire cost of the service if they see an out-of-network provider. Most benefits are covered out-of-network but at a higher cost. The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers. - ✔✔ What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3) They must see contracted network providers in order to receive coverage under the plan. In most cases, they will pay the entire cost of the service if they see an out-of-network provider. Most benefits are covered out-of-network but at a higher cost. The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers. - ✔✔In most cases, they will pay the entire cost of the service if they see an out-of-network provider. Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers. When does Medicare Supplement Open Enrollment take place? During the three months prior to the consumer's 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B. During the first six months a consumer is 65 or older and enrolled in Medicare Part B. Annually from October 15 to December 7. During the first three months a consumer is 65 or older and enrolled in Medicare Part B. - ✔✔During the first six months a consumer is 65 or older and enrolled in Medicare Part B. How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? The OOP maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-covered health care services each year. The OOP maximum is a feature that limits the amount of money a consumer will have to spend on all health care services each year. The OOP maximum is a feature that limits the amount of money a consumer will have to spend on prescription drugs and plan premiums each year. - ✔✔ Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy. When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel. The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application. The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with an MA Plan. - ✔✔Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy.
Initial coverage is the stage when the plan pays part and the member pays part, usually as coinsurance or copayments. A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. The coverage gap ends when the member has spent $6,550 (in 2021) in out-of-pocket expenses for the plan year. - ✔✔A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. Which of the following options are drug utilization management (UM) rules? (Select 3 - ✔✔Quantity Limit Prior Authorization Step Therapy 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 - ✔✔ 63 continuous days or more Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Through a combination of subsidies and annual refund checks Through subsidies such as lower or no monthly plan premiums and lower or no copayments Such financial assistance will no longer be available as of January 1, 2020 By receiving annual checks with a refund based on a predetermined percentage of Part D costs - ✔✔Through subsidies such as lower or no monthly plan premiums and lower or no copayments Medications that are covered in a Plan's formulary have various levels of associated member cost- sharing (copayments or coinsurance). What are these drug levels called? - ✔✔Drug tiers Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies?
Underwriting is required if the consumer is not in his/her Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. Consumers will never be underwritten to determine their rate. If the consumer meets Guaranteed Issue criteria, he/she may be underwritten to determine his/her rate. During Medicare Supplement Open Enrollment, consumers will only be required to answer the underwriting eligibility questions. - ✔✔Underwriting is required if the consumer is not in his/her Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F. Consumers already enrolled in Plans C or F are required to change plans. Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose. - ✔✔Consumers already enrolled in Plans C or F are required to change plans. Which of the following is true about Medicare Supplement Insurance Plans? They are regulated by the Centers for Medicare & Medicaid Services (CMS). Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. To see a specialist, insured members must obtain referrals from a primary care physician. They can only be purchased during the Annual Election Period (AEP). - ✔✔
