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UHC MEDICARE
CERTIFICATION EXAM
2026-2027 EDITION
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Actual Questions & Answers | Verified | Graded A+
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◆ ◇ ◆ ◇ ◆
Medicare coverage • enrollment • compliance • member service
UHC Medicare Certification Exam | 1
,UHC Medicare Certification Exam | 2
,Section 1: Brief Introduction
This 150-question UHC Medicare certification exam-prep guide reviews Medicare Parts A, B, C,
and D; Medicare Advantage and Special Needs Plans; enrollment periods; marketing and scope
rules; FWA and ethics; dual eligibility; grievances and appeals; agent responsibilities;
networks; member resources; and Star Ratings. Each item presents a compliance-focused
scenario followed by the correct answer and rationale.
Section 2: The Complete Exam
1. A beneficiary is turning 65.
A. explain eligibility and Parts A and B coverage accurately, identify coordination-of-benefits
issues, and direct the beneficiary to official plan or Medicare resources
B. promise coverage without checking the plan
C. treat all beneficiaries as having identical eligibility
D. confuse Part A, Part B, and supplemental coverage
Answer: A. explain eligibility and Parts A and B coverage accurately, identify coordination-of-
benefits issues, and direct the beneficiary to official plan or Medicare resources Rationale:
Medicare eligibility and coverage depend on age, disability, qualifying conditions, enrollment status, and
coordination with other coverage. Part A and Part B have distinct benefits and cost-sharing; plan-
specific details must be verified before advising a beneficiary.
2. A beneficiary asks about Part A hospital coverage.
A. describe Part B as inpatient insurance
B. distinguish Part A, Part B, supplemental, and plan benefits and confirm coverage, cost
sharing, authorization, and network rules before making a statement
C. guarantee coverage for every service
D. ignore plan authorization requirements
Answer: B. distinguish Part A, Part B, supplemental, and plan benefits and confirm coverage,
cost sharing, authorization, and network rules before making a statement Rationale: Part A
generally addresses inpatient or facility benefits while Part B addresses medically necessary
professional and outpatient services, subject to rules and cost sharing. Coverage, authorization, and
network requirements depend on the beneficiary’s coverage pathway.
3. A beneficiary enrolls in a Medicare Advantage plan.
A. describe every PPO as having no network rules
B. promise out-of-network coverage at in-network cost
C. explain plan type, network, referral, authorization, benefit, and enrollment rules using the
current plan materials
D. assume all SNPs have identical eligibility criteria
Answer: C. explain plan type, network, referral, authorization, benefit, and enrollment rules
using the current plan materials Rationale: Medicare Advantage plans administer Medicare-covered
UHC Medicare Certification Exam | 3
, benefits under plan rules. HMOs, PPOs, and SNPs can differ in networks, referrals, authorization, cost
sharing, and eligibility; current plan documents control.
4. A beneficiary asks what Part D covers.
A. say every drug is covered
B. tell the member to stop a medication
C. ignore exception and appeal rights
D. explain formulary, tier, utilization-management, pharmacy-network, exception, and
assistance concepts without guaranteeing a drug outcome
Answer: D. explain formulary, tier, utilization-management, pharmacy-network, exception,
and assistance concepts without guaranteeing a drug outcome Rationale: Part D plans use
formularies, tiers, pharmacy networks, and utilization management such as prior authorization or step
therapy. Members may have exception, grievance, appeal, or subsidy pathways; medication changes
should involve the prescriber.
5. A beneficiary is in the Initial Enrollment Period.
A. identify the applicable enrollment period and qualifying event, explain timing and effective-
date rules accurately, and use official resources for confirmation
B. promise any change can occur year-round
C. apply AEP rules to every situation
D. ignore late-enrollment consequences
Answer: A. identify the applicable enrollment period and qualifying event, explain timing and
effective-date rules accurately, and use official resources for confirmation Rationale: Medicare
enrollment periods differ in purpose, eligibility, timing, and effective dates. IEP, AEP, OEP, and SEPs
should not be conflated; qualifying events and prior credible coverage can affect options and penalties.
6. A beneficiary receives a marketing call.
A. represent education as a sales event
B. follow current CMS marketing, permission, event, contact, scope, privacy, and material-
disclosure requirements
C. contact every resident without permission
D. compare plans using unapproved materials
Answer: B. follow current CMS marketing, permission, event, contact, scope, privacy, and
material-disclosure requirements Rationale: Medicare marketing is regulated to protect
beneficiaries from misleading, coercive, or unsolicited practices. Agents must use approved materials
and follow permission, event, contact, scope, privacy, and disclosure rules.
7. A beneficiary schedules a plan appointment.
A. discuss every product automatically
B. treat a signature as permission for unrelated sales
C. document and honor the agreed scope, obtain appropriate permission before expanding it,
and provide accurate plan-specific information
D. ignore cancellation or contact preferences
UHC Medicare Certification Exam | 4
▲ ╱╲ ╱╲ ╱╲
· · · · · · ·
━━━━━━━━━━━━━━━━
UHC MEDICARE
CERTIFICATION EXAM
2026-2027 EDITION
━━━━━━━━━━━━━━━━
Actual Questions & Answers | Verified | Graded A+
· · · · · · ·
◆ ◇ ◆ ◇ ◆
Medicare coverage • enrollment • compliance • member service
UHC Medicare Certification Exam | 1
,UHC Medicare Certification Exam | 2
,Section 1: Brief Introduction
This 150-question UHC Medicare certification exam-prep guide reviews Medicare Parts A, B, C,
and D; Medicare Advantage and Special Needs Plans; enrollment periods; marketing and scope
rules; FWA and ethics; dual eligibility; grievances and appeals; agent responsibilities;
networks; member resources; and Star Ratings. Each item presents a compliance-focused
scenario followed by the correct answer and rationale.
Section 2: The Complete Exam
1. A beneficiary is turning 65.
A. explain eligibility and Parts A and B coverage accurately, identify coordination-of-benefits
issues, and direct the beneficiary to official plan or Medicare resources
B. promise coverage without checking the plan
C. treat all beneficiaries as having identical eligibility
D. confuse Part A, Part B, and supplemental coverage
Answer: A. explain eligibility and Parts A and B coverage accurately, identify coordination-of-
benefits issues, and direct the beneficiary to official plan or Medicare resources Rationale:
Medicare eligibility and coverage depend on age, disability, qualifying conditions, enrollment status, and
coordination with other coverage. Part A and Part B have distinct benefits and cost-sharing; plan-
specific details must be verified before advising a beneficiary.
2. A beneficiary asks about Part A hospital coverage.
A. describe Part B as inpatient insurance
B. distinguish Part A, Part B, supplemental, and plan benefits and confirm coverage, cost
sharing, authorization, and network rules before making a statement
C. guarantee coverage for every service
D. ignore plan authorization requirements
Answer: B. distinguish Part A, Part B, supplemental, and plan benefits and confirm coverage,
cost sharing, authorization, and network rules before making a statement Rationale: Part A
generally addresses inpatient or facility benefits while Part B addresses medically necessary
professional and outpatient services, subject to rules and cost sharing. Coverage, authorization, and
network requirements depend on the beneficiary’s coverage pathway.
3. A beneficiary enrolls in a Medicare Advantage plan.
A. describe every PPO as having no network rules
B. promise out-of-network coverage at in-network cost
C. explain plan type, network, referral, authorization, benefit, and enrollment rules using the
current plan materials
D. assume all SNPs have identical eligibility criteria
Answer: C. explain plan type, network, referral, authorization, benefit, and enrollment rules
using the current plan materials Rationale: Medicare Advantage plans administer Medicare-covered
UHC Medicare Certification Exam | 3
, benefits under plan rules. HMOs, PPOs, and SNPs can differ in networks, referrals, authorization, cost
sharing, and eligibility; current plan documents control.
4. A beneficiary asks what Part D covers.
A. say every drug is covered
B. tell the member to stop a medication
C. ignore exception and appeal rights
D. explain formulary, tier, utilization-management, pharmacy-network, exception, and
assistance concepts without guaranteeing a drug outcome
Answer: D. explain formulary, tier, utilization-management, pharmacy-network, exception,
and assistance concepts without guaranteeing a drug outcome Rationale: Part D plans use
formularies, tiers, pharmacy networks, and utilization management such as prior authorization or step
therapy. Members may have exception, grievance, appeal, or subsidy pathways; medication changes
should involve the prescriber.
5. A beneficiary is in the Initial Enrollment Period.
A. identify the applicable enrollment period and qualifying event, explain timing and effective-
date rules accurately, and use official resources for confirmation
B. promise any change can occur year-round
C. apply AEP rules to every situation
D. ignore late-enrollment consequences
Answer: A. identify the applicable enrollment period and qualifying event, explain timing and
effective-date rules accurately, and use official resources for confirmation Rationale: Medicare
enrollment periods differ in purpose, eligibility, timing, and effective dates. IEP, AEP, OEP, and SEPs
should not be conflated; qualifying events and prior credible coverage can affect options and penalties.
6. A beneficiary receives a marketing call.
A. represent education as a sales event
B. follow current CMS marketing, permission, event, contact, scope, privacy, and material-
disclosure requirements
C. contact every resident without permission
D. compare plans using unapproved materials
Answer: B. follow current CMS marketing, permission, event, contact, scope, privacy, and
material-disclosure requirements Rationale: Medicare marketing is regulated to protect
beneficiaries from misleading, coercive, or unsolicited practices. Agents must use approved materials
and follow permission, event, contact, scope, privacy, and disclosure rules.
7. A beneficiary schedules a plan appointment.
A. discuss every product automatically
B. treat a signature as permission for unrelated sales
C. document and honor the agreed scope, obtain appropriate permission before expanding it,
and provide accurate plan-specific information
D. ignore cancellation or contact preferences
UHC Medicare Certification Exam | 4
