UHC LEARNING WORKBOOK
GUIDANCE MANUAL ENTIRE
QUESTION ARRAY WITH SOLUTION
SETS
Medicare Answer: Federal health insurance program
Medicare is administered by whom? Answer: CMS ( Centers for
medicare and medicaid services)
Parts A & B of medicare are Answer: federal health insurance
program referred to as original medicare
Part A? Answer: Hospital insurance
Part B? Answer: Medical insurance
What doesnt medicare cover? Answer: routine dental, eye care
hearing exam,deductibles, coinsurance and copayments
Part C? Answer: Medicare Advantage Plans
MA covers? Answer: Part A &B coverage, and some part D coverage
MA plans are not? Answer: Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? Answer:
MADP
do MAP's have a annual maximum OOP maximum that limits the
amount of money a member must spend every year for covered
services? Answer: YES
MA plans integrate what type of additonal coverage? Answer: part D
prescription drug coverage
If a customer wants to keep their stand alone prescription drug plan,
what may the customer want to enroll in? Answer: MA-only PFFS
plan
,What is a stand alone drug plan called? Answer: PDP
WHat is PFFS? Answer: Private Fee for Service (PFFS) - Plans that
allow you to go to any doctor or hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want
because it gives them freedom to access doctors that may not be in
their network? Answer: PFFS plan
Do HMO's require referals? Answer: Yes
Do PPO's require a referal? Answer: No
When a member enrolls in a MA plan, they receive their coverage
from medicare or the MA plan? Answer: MA plan
When a customer is enrolled in a MA plan, they must continue paying
their premiums for what other plan? Answer: Part B
MA plans have a maxium annual limit on OOP costs called a?
Answer: MOOP amount ( Maxium out of pocket)
When a member is enrolled in a MA plan, they are automatically
disenrolled from any other MA plan or PDP( prescription drug plan)
in which they are enrolled as of the new plans_____? Answer:
effective date
An exception exisits for MA-only PFFS plans as a member can also
be enrolled in a what? Answer: Stand alone PDP
If a member enrolls in a MA plan, what must the member do?
Answer: Cancel in writing their medicare supplement insurance
policy with the carrier after their request to enroll in MA plan has
been approved.
Medicare supplement insurance policies cannot be used in
conjunction with what type of plan? Answer: MA plan
A medicare supplement insurance plan helps to cover some of the
OOP costs associated with? Answer: original medicare.
, A medicare supplement insurance plan does NOT pay the cost-sharing
of what type of plan? Answer: MA plan
when a client enrolls in a MA plan, will it automatically terminate
their MA plan? Answer: NO
Can a customer call to terminate their Med Sup plan? Answer: no it
must be done in writing
What are the different types of MA plans? Answer: HMO, POS, PPO,
RPPO, PFFS, SNP, and MSA
For an HMO, they customer must us IN network providers, what are
the exceptions to their rule? Answer: Emergencies, Urgent care, and
renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they
require referrals to see a specialist? Answer: Yes
In a POS plan, does a member need a referral from their PCP to see a
specialist? Answer: yes
Can a member with a POS plan see a specialist? Answer: Yes, but
they may have to pay a higher cost, and there coverage limits
With a PFFS plan, can a member seek treatment from any medicare
eligible provider who agrees to accept the plans conditions and
payment rates? Answer: Yes
Does a PCP need to be selected with a PFFS plan? Answer: No
What is the only plan to offer non-network PFFS plans? Answer:
UHC
What are SNP's for? ( Dual SNP) Answer: People who have both
medicare and Medicaid
Institutional SNP? Answer: Nursing homes
Chronic condition SNP? Answer: people who have certain chronic
medical conditions
GUIDANCE MANUAL ENTIRE
QUESTION ARRAY WITH SOLUTION
SETS
Medicare Answer: Federal health insurance program
Medicare is administered by whom? Answer: CMS ( Centers for
medicare and medicaid services)
Parts A & B of medicare are Answer: federal health insurance
program referred to as original medicare
Part A? Answer: Hospital insurance
Part B? Answer: Medical insurance
What doesnt medicare cover? Answer: routine dental, eye care
hearing exam,deductibles, coinsurance and copayments
Part C? Answer: Medicare Advantage Plans
MA covers? Answer: Part A &B coverage, and some part D coverage
MA plans are not? Answer: Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? Answer:
MADP
do MAP's have a annual maximum OOP maximum that limits the
amount of money a member must spend every year for covered
services? Answer: YES
MA plans integrate what type of additonal coverage? Answer: part D
prescription drug coverage
If a customer wants to keep their stand alone prescription drug plan,
what may the customer want to enroll in? Answer: MA-only PFFS
plan
,What is a stand alone drug plan called? Answer: PDP
WHat is PFFS? Answer: Private Fee for Service (PFFS) - Plans that
allow you to go to any doctor or hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want
because it gives them freedom to access doctors that may not be in
their network? Answer: PFFS plan
Do HMO's require referals? Answer: Yes
Do PPO's require a referal? Answer: No
When a member enrolls in a MA plan, they receive their coverage
from medicare or the MA plan? Answer: MA plan
When a customer is enrolled in a MA plan, they must continue paying
their premiums for what other plan? Answer: Part B
MA plans have a maxium annual limit on OOP costs called a?
Answer: MOOP amount ( Maxium out of pocket)
When a member is enrolled in a MA plan, they are automatically
disenrolled from any other MA plan or PDP( prescription drug plan)
in which they are enrolled as of the new plans_____? Answer:
effective date
An exception exisits for MA-only PFFS plans as a member can also
be enrolled in a what? Answer: Stand alone PDP
If a member enrolls in a MA plan, what must the member do?
Answer: Cancel in writing their medicare supplement insurance
policy with the carrier after their request to enroll in MA plan has
been approved.
Medicare supplement insurance policies cannot be used in
conjunction with what type of plan? Answer: MA plan
A medicare supplement insurance plan helps to cover some of the
OOP costs associated with? Answer: original medicare.
, A medicare supplement insurance plan does NOT pay the cost-sharing
of what type of plan? Answer: MA plan
when a client enrolls in a MA plan, will it automatically terminate
their MA plan? Answer: NO
Can a customer call to terminate their Med Sup plan? Answer: no it
must be done in writing
What are the different types of MA plans? Answer: HMO, POS, PPO,
RPPO, PFFS, SNP, and MSA
For an HMO, they customer must us IN network providers, what are
the exceptions to their rule? Answer: Emergencies, Urgent care, and
renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they
require referrals to see a specialist? Answer: Yes
In a POS plan, does a member need a referral from their PCP to see a
specialist? Answer: yes
Can a member with a POS plan see a specialist? Answer: Yes, but
they may have to pay a higher cost, and there coverage limits
With a PFFS plan, can a member seek treatment from any medicare
eligible provider who agrees to accept the plans conditions and
payment rates? Answer: Yes
Does a PCP need to be selected with a PFFS plan? Answer: No
What is the only plan to offer non-network PFFS plans? Answer:
UHC
What are SNP's for? ( Dual SNP) Answer: People who have both
medicare and Medicaid
Institutional SNP? Answer: Nursing homes
Chronic condition SNP? Answer: people who have certain chronic
medical conditions
