UHC MEDICARE CERTIFICATION
NEWEST EXAM (VERSION A AND B)
COMPLETE ACCURATE EXAM
QUESTIONS WITH DETAILED
VERIFIED ANSWERS GRADED A+
What does MMP do? - ANS-individuals can receive both medicare parts A &B and full
medicaid benefits through one health plan
Generally, qualified individuals are passively enrolled into the state's coordinated care plan with
the ability to opt-out and choose other medicare - ANS-options
Why would someone want to enroll in a MA-only PFFS plan? - ANS-they want to keep their
stand alone prescription drug plan (PDP)
when a member enrolls in a different MA plan offered by the same MA organization, his/her
year to date contribution toward the annual OOP maximum plan is what? - ANS-is counted
towards his/her MOOP in the new MA plan IF:
1) the new plan is the same type as the previous plan ( eg HMO to HMO) and both plans are
on the contract and/or have the same legal entity
2) the new plan is a different type than the previous plan ( eg HMO to PPO) and both plans
have the SAME legal entity
,If a member is switching from one MA plan to another, does the member have to be apart of
the same carrier to retain his/her MOOP expenses? - ANS-yes. if the member is from a
different carrier, the MOOP expense will NOT carry over to the new plans yearly deductible
What type of plans are network based plans? - ANS-HMO's, POS's, and PPO's
What type of plan can either be network based or non- network based? - ANS-PFFO
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? - ANS-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)
Is emergency care covered in a PFFO plan regardless of whether the provider agrees to accept
the plans payment? - ANS-yes it is`
Who allows the PFFS plan to decide if balance billing is permitted? - ANS-CMS. Plans must
disclose what is permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes? - ANS-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) - ANS-disenrolled
what happens when a customer is enrolled in a employee or union sponsored health plan and
decides to enroll in a PDP? - ANS-the customer MAY lose coverage for themselves and their
, dependents upon enrollment in a PDP, and may not be able to re-enroll in the employer or
union plan at a later date
in an employer/union-sponsored group retiree plan, or more specifically a subsidized plan, the
employer contributes to the premium, but with an endorsed plan, the employer _____? - ANS-
does not contribute
WHat kind of medicare plan is only available through employer groups? - ANS-employer senior
supplement group retiree plans
does an employer senior supplement group retiree plan help pay for some or all the costs not
covered by original medicare? - ANS-yes. not only that but they have similar coverage as
medicare supplement insurance plans and members can go to any provider that accepts
medicare
Medicare - ANS-Federal health insurance program
Medicare is administered by whom? - ANS-CMS ( Centers for medicare and medicaid services)
Parts A & B of medicare are - ANS-federal health insurance program referred to as original
medicare
Part A? - ANS-Hospital insurance
Part B? - ANS-Medical insurance
What doesnt medicare cover? - ANS-routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
Part C? - ANS-Medicare Advantage Plans
NEWEST EXAM (VERSION A AND B)
COMPLETE ACCURATE EXAM
QUESTIONS WITH DETAILED
VERIFIED ANSWERS GRADED A+
What does MMP do? - ANS-individuals can receive both medicare parts A &B and full
medicaid benefits through one health plan
Generally, qualified individuals are passively enrolled into the state's coordinated care plan with
the ability to opt-out and choose other medicare - ANS-options
Why would someone want to enroll in a MA-only PFFS plan? - ANS-they want to keep their
stand alone prescription drug plan (PDP)
when a member enrolls in a different MA plan offered by the same MA organization, his/her
year to date contribution toward the annual OOP maximum plan is what? - ANS-is counted
towards his/her MOOP in the new MA plan IF:
1) the new plan is the same type as the previous plan ( eg HMO to HMO) and both plans are
on the contract and/or have the same legal entity
2) the new plan is a different type than the previous plan ( eg HMO to PPO) and both plans
have the SAME legal entity
,If a member is switching from one MA plan to another, does the member have to be apart of
the same carrier to retain his/her MOOP expenses? - ANS-yes. if the member is from a
different carrier, the MOOP expense will NOT carry over to the new plans yearly deductible
What type of plans are network based plans? - ANS-HMO's, POS's, and PPO's
What type of plan can either be network based or non- network based? - ANS-PFFO
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? - ANS-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)
Is emergency care covered in a PFFO plan regardless of whether the provider agrees to accept
the plans payment? - ANS-yes it is`
Who allows the PFFS plan to decide if balance billing is permitted? - ANS-CMS. Plans must
disclose what is permitted in the terms and conditions
Does the OEP( Open enrollment period) allow for PDP changes? - ANS-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) - ANS-disenrolled
what happens when a customer is enrolled in a employee or union sponsored health plan and
decides to enroll in a PDP? - ANS-the customer MAY lose coverage for themselves and their
, dependents upon enrollment in a PDP, and may not be able to re-enroll in the employer or
union plan at a later date
in an employer/union-sponsored group retiree plan, or more specifically a subsidized plan, the
employer contributes to the premium, but with an endorsed plan, the employer _____? - ANS-
does not contribute
WHat kind of medicare plan is only available through employer groups? - ANS-employer senior
supplement group retiree plans
does an employer senior supplement group retiree plan help pay for some or all the costs not
covered by original medicare? - ANS-yes. not only that but they have similar coverage as
medicare supplement insurance plans and members can go to any provider that accepts
medicare
Medicare - ANS-Federal health insurance program
Medicare is administered by whom? - ANS-CMS ( Centers for medicare and medicaid services)
Parts A & B of medicare are - ANS-federal health insurance program referred to as original
medicare
Part A? - ANS-Hospital insurance
Part B? - ANS-Medical insurance
What doesnt medicare cover? - ANS-routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
Part C? - ANS-Medicare Advantage Plans
