UHC CERTIFICATION 2 LATEST VERSIONS
QUESTIONS AND VERIFIED ANSWERS WITH A 2025-
2026
Before enrolling a customer in a MA plan, you must verify the network
status of each provider the customer currently uses or intends to use by
checking what? - Correct Answer - the plans provider directory or by
contacting the plan. If possible, use an online directory over a printed
directory as they are more current. Remind the customer to check their
providers status before receiving care to ensure that their network status
has not changed. (see provider search job aid on Jarvis, UHC's agent
portal)
What is creditable coverage? - Correct Answer - it’s a prescription drug
coverage that is expected to pay on average at least as much as
Medicare’s standard prescription drug coverage
consumers with limited _____ may qualify for extra help from Medicare to
cover their part D premiums and Part D related OOP costs - Correct
Answer - income and resources
TO qualify for low-income subsidy on part D, the consumers income must
be at or below - Correct Answer - 150% of the FPL (federal poverty level)
What are some examples of creditable coverage? - Correct Answer - drug
plan from an employer, union, TRICARE, Indian health service, or
department of veteran’s affairs
when does approved extra help begin? - Correct Answer - the first day of
the month the customer becomes eligible
pg. 1
, What is a PDP? - Correct Answer - a standalone Medicare prescription
drug plan
What do PDP's do? - Correct Answer - add prescription drug coverage to
original Medicare, MSA's, some Medicare cost plans, and some Medicare
private fee for service PFFS plans
What type of standalone variations to Medicare can give extra benefits? -
Correct Answer - A+B+D
C+D
When a consumer has original Medicare and a prescription drug plan, they
can also have a Medicare________ insurance plan - Correct Answer -
Medicare supplement insurance plan
There are 4 stages to Medicare part standard prescription drug coverage;
what are they? - Correct Answer - 1) yearly deductible
2) initial coverage
3) Coverage gap
4) Catastrophic coverage
To determine when a member moves from one stage to the next in
Medicare prescription drug coverage, the plan keeps track of the members
Troop costs. What does Troop stand for? - Correct Answer - True out of
pocket
Any money spent during the deductible, initial coverage, and coverage gap
stages counts towards the Troop costs. What doesn't count toward the
Troop costs? - Correct Answer - The monthly premium
pg. 2
, What type of plans are network-based plans? - Correct Answer - HMO's,
POS's, and PPO's
What type of plan can either be network based or non- network based? -
Correct Answer - PFFO
Is emergency care covered in a PFFO plan regardless of whether the
provider agrees to accept the plans payment? - Correct Answer - yes, it is`
Who allows the PFFS plan to decide if balance billing is permitted? -
Correct Answer - CMS. Plans must disclose what is permitted in the terms
and conditions
Does the OEP (Open enrollment period) allow for PDP changes? - Correct
Answer - No you can’t make changes to PDP during the OEP
If a customer enrolled in a MAP (with or without prescription drug
coverage), will be automatically ________from that plan and returned to
original Medicare upon enrolling in a PDP (except MA-only PFFS plans) -
Correct Answer - disenrolled
What is the coverage gap for Medicare prescription drug coverage? -
Correct Answer - It’s a temporary limit on what the Medicare prescription
drug plan will cover
pg. 3
QUESTIONS AND VERIFIED ANSWERS WITH A 2025-
2026
Before enrolling a customer in a MA plan, you must verify the network
status of each provider the customer currently uses or intends to use by
checking what? - Correct Answer - the plans provider directory or by
contacting the plan. If possible, use an online directory over a printed
directory as they are more current. Remind the customer to check their
providers status before receiving care to ensure that their network status
has not changed. (see provider search job aid on Jarvis, UHC's agent
portal)
What is creditable coverage? - Correct Answer - it’s a prescription drug
coverage that is expected to pay on average at least as much as
Medicare’s standard prescription drug coverage
consumers with limited _____ may qualify for extra help from Medicare to
cover their part D premiums and Part D related OOP costs - Correct
Answer - income and resources
TO qualify for low-income subsidy on part D, the consumers income must
be at or below - Correct Answer - 150% of the FPL (federal poverty level)
What are some examples of creditable coverage? - Correct Answer - drug
plan from an employer, union, TRICARE, Indian health service, or
department of veteran’s affairs
when does approved extra help begin? - Correct Answer - the first day of
the month the customer becomes eligible
pg. 1
, What is a PDP? - Correct Answer - a standalone Medicare prescription
drug plan
What do PDP's do? - Correct Answer - add prescription drug coverage to
original Medicare, MSA's, some Medicare cost plans, and some Medicare
private fee for service PFFS plans
What type of standalone variations to Medicare can give extra benefits? -
Correct Answer - A+B+D
C+D
When a consumer has original Medicare and a prescription drug plan, they
can also have a Medicare________ insurance plan - Correct Answer -
Medicare supplement insurance plan
There are 4 stages to Medicare part standard prescription drug coverage;
what are they? - Correct Answer - 1) yearly deductible
2) initial coverage
3) Coverage gap
4) Catastrophic coverage
To determine when a member moves from one stage to the next in
Medicare prescription drug coverage, the plan keeps track of the members
Troop costs. What does Troop stand for? - Correct Answer - True out of
Any money spent during the deductible, initial coverage, and coverage gap
stages counts towards the Troop costs. What doesn't count toward the
Troop costs? - Correct Answer - The monthly premium
pg. 2
, What type of plans are network-based plans? - Correct Answer - HMO's,
POS's, and PPO's
What type of plan can either be network based or non- network based? -
Correct Answer - PFFO
Is emergency care covered in a PFFO plan regardless of whether the
provider agrees to accept the plans payment? - Correct Answer - yes, it is`
Who allows the PFFS plan to decide if balance billing is permitted? -
Correct Answer - CMS. Plans must disclose what is permitted in the terms
and conditions
Does the OEP (Open enrollment period) allow for PDP changes? - Correct
Answer - No you can’t make changes to PDP during the OEP
If a customer enrolled in a MAP (with or without prescription drug
coverage), will be automatically ________from that plan and returned to
original Medicare upon enrolling in a PDP (except MA-only PFFS plans) -
Correct Answer - disenrolled
What is the coverage gap for Medicare prescription drug coverage? -
Correct Answer - It’s a temporary limit on what the Medicare prescription
drug plan will cover
pg. 3
