Download UHC Medicare Certifications Exam Prep 2025-2026: Q&A and more Exams Management of Health Service in PDF only on Docsity!
UHC CERTIFICATIONS EXAM PREP| 2025 - 2026|ACTUAL 94
QUESTIONS &ANSWERS WITH RATIONALES|VERIFIED|A+
GRADE GUARANTEE
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? ANS:->>>Herenrollment 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 whowants to enroll in a Medicare Supplement Insurance Plan? ANS:->>>Whena 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 morethan 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? ANS:->>>Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)ANS:-
- 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 includeMedicare prescription drug coverage.
Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? ANS:->>>Does not have any pre-existingconditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? ANS:-
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? ANS:->>>(INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain servicesoutside the network. What is true about Medicare supplement open enrollment? ANS:->>>(INCORRECT) A Whena 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 morethan 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? ANS:->>>Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)ANS:- >>>1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits. 2. MA Plans provide Medicare hospital and medical insurance and often includeMedicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? ANS:->>>Does not have any pre-existingconditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? ANS:- >>>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? ANS:->>>(INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain servicesoutside the network. What is true about Medicare supplement open enrollment? ANS:->>>(INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 orolder cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a MedicareSupplement Insurance Plan. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)ANS:- >>>1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits. 2. MA Plans provide Medicare hospital and medical insurance and often includeMedicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? ANS:->>>Does not have any pre-existingconditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? ANS:- >>>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? ANS:->>>(INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain servicesoutside the network. What is true about Medicare supplement open enrollment? ANS:->>>(INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 orolder cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a MedicareSupplement 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? ANS:->>>The Out-of-Pocket Maximum will include her coststoward any Medicare-covered Part A or B
Which of the following statements does NOT correctly define prescription drugstages? ANS:->>>A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. Which of these statements is NOT true about the drug utilization management (UM) rules? ANS:->>>(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 NOTenroll 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? ANS:->>>Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? ANS:->>>Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: ANS:->>>A list of medications covered within thebenefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwritingcriteria
in states where underwriting applies? ANS:->>>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), whichwent into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. ANS:-
True Which of the following is NOT true of Medicare Supplement Insurance Plans? ANS:- (INCORRECT) Plan benefit amounts automatically update whenMedicare 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? ANS:->>>Consumers age 65 or older, consumersunder 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) ANS:->>>An MA Plan is a health plan option approved by Medicare andoffered by private insurance companies. An MA Plan provides Medicare hospital and medical insurance (Medicare Part Aand Part
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? ANS:->>>They could enroll in a stand-aloneMedicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? ANS:->>>Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limitand Limited Access are all examples of what? ANS:->>>Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOTenroll 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 Bor went without creditable prescription drug coverage for. ANS:->>> 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifiesfor Low Income Subsidy for their part of Medicare Part D costs? ANS:->>>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? ANS:->>>Preferred Generics, Generics, Preferred Brand (and some higher- cost generics), Non-Preferred Drug (and some higher-costgenerics), 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? ANS:->>>Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? ANS:->>>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? ANS:->>>April 1 through October 31
enrolling, in which plan they are enrolling, as well as the standard disclosures. ANS:-
Statement of Understanding What is Scope of Appointment? ANS:->>>The agreement obtained from theconsumer to that identifies the scope of products that can be discussed at a personal/individual marketing appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Whichoption should Jane consider? ANS:->>>Jane should ask Albert if someone,such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Melanie is currently enrolled in a Medicare Supplement Insurance Plan and a PDP.Assuming she has a valid election period, what would happen if she enrolled in an HMO MAPD plan? ANS:->>>(INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. Medicare Advantage (MA) organization must disenroll a member from an MA planin which situation? ANS:->>>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 isin a valid election period. Which option is available to Aries? ANS:->>>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? ANS:->>>A product thatis suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interestedin 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? ANS:->>>Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? ANS:->>>AARP endorses UnitedHealthcareMA, 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 withto feel their relationship with AARP is. ANS:->>>Effortless and inspiring
AARP advocates for the 50+ population in congress for legislation to lowermedical costs. Which of the following is TRUE about the production requirement for the Authorized to Offer Elite status? ANS:->>>Each calendar year, agents needto have at least 30 commission-eligible, accepted, and paid 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 Answer: Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)ANS:-
MA, PDP, Supplements Dual Special Needs Plans (D-SNP) are defined as which of the following: ANS:- 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? ANS:->>>Upon notification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a D-SNP? ANS:->>>Joe, who
receives Qualified Medicaid Beneficiary benefits (QMB+) Which statement best describes a care management program that varies dependingupon the level of the member's health risk? ANS:->>>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. ANS:->>>D-SNPs are network-based When selling D-SNPs, agents must: ANS:->>>Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled inPart B Which consumer may be a good candidate for a D-SNP? ANS:->>>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: ANS:->>>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? ANS:->>>Joy has a cardiovascular disorder, is enrolled
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 forcost sharing? ANS:-
All, such as premiums, deductibles, copayments,and coinsurance What type of event must an agent conduct when they want to be able to collectconsumer information, schedule future appointments, and accept enrollment applications? ANS:- Marketing/sales event Which of the following does not describe a personal/individual marketing appointment? ANS:->>>It needs to be reported to UnitedHealthcare prior toadvertising 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 theAmericans with Disabilities Act (ADA). Which of the following is not an ADArequirement? ANS:- Extra-wide sidewalks that accommodate wheelchairs Which of the following elements does not need to be entered on the NEW EventRequest Form when reporting a new event? ANS:->>>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 tocancel 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? ANS:->>>Jeff is prohibited from canceling the event because itis 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 for9 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 hisevent on time, he advertises the event to start at 9:30 a.m. What event reporting infraction(s) might Sam incur? ANS:->>>(INCORRECT) None, Sam reported the event prior to advertising and not less than 7 calendar days prior to thedate of the event Marcus is planning an educational event and has decided to place an advertisementin the local paper. What must the advertisement include? ANS:->>>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 other giveaways does not exceed $15 per person? (Select 2) ANS:->>>Coffee, juice, fresh
not able to ask the plan for exceptions to any utilization management rules At an informal marketing/sales event, which of the following activities is notpermitted? ANS:->>>Approaching consumers as they pass by your booth/kiosk/table Agent Santana has developed a relationship with Dr. Westberry, a Primary Care Provider contracted with several Medicare Advantage Plans. Dr. Westberry is asked to attend a formal marketing/sales event conducted by Agent Santana. Whichof Dr. Westberry's actions is non-compliant? ANS:->>>Offers blood pressure screenings as consumers wait for the event to begin Which of the following best describes the purpose of event observation? ANS:->>>An oversight activity where an individual evaluates an event as a meansto 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? ANS:->>>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? ANS:->>>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 interpreterservices? ANS:->>>Whenever the agent is presenting a Medicare Advantage or Prescription Drug Plan.
