UHC Certification Complete Solution With
Questions And Answers
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare
helps cover the costs of his inpatient hospital stay? Correct Answers: Part A
Correct Answers: The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? Correct Answers: Consumers age
65 or older, consumers under 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? Correct Answers: MA Plans are
health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she
meet? (Select the two answers that apply.) Correct Answers: Not have End Stage Renal Disease
(permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA
Plan? (Select 3) Correct Answers:
Which of the following are MA Plans that focus on using network providers to maximize the benefits
and reduce out-of-network expenses? Correct Answers: HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment? Correct Answers: By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and enrolled in
Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? Correct Answers: The
OOP maximum is a feature that limits the amount of money a consumer will have to spend on
Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug Plan
(PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug
coverage? Correct Answers: The consumer will be automatically disenrolled from their stand-alone
PDP upon enrollment in the MA Plan that has integrated prescription drug coverage
A government program, offered only through a private insurance company or other private company
approved by Medicare, that provides prescription drug coverage describes which of the following:
Correct Answers: Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Prescription Drug
Plans? Correct Answers: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare
Part B
, What are two options for Medicare consumers to get Part D prescription drug coverage (assuming
they meet all eligibility requirements)? (Select 2) Correct Answers:
Which of the following statements is not true about the Coverage Gap? Correct Answers: All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) Correct
Answers:
Which of the following best describes the Late Enrollment Penalty (LEP)? Correct Answers: The
amount added to the member's monthly plan premium if they did not enroll 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 continuous
days or more.
Through which means is financial assistance offered to a consumer who qualifies for Low Income
Subsidy for their part of Medicare Part D costs? Correct Answers: Through subsidies such as lower
or no monthly plan premiums and lower or no copayments
Medications that are covered in a Plan's formulary have various levels of associated member cost-
sharing (copayments or coinsurance). What are these drug levels called? Correct Answers: Drug tiers
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following
underwriting criteria apply EXCEPT: Correct Answers: Consumers may be underwritten to determine
their acceptance and, if applicable, their rate.
The new MACRA legislation, which went into effect January 1, 2020, applies to all carriers offering
Medicare supplement plans. Correct Answers: TRUE
Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answers: Plan
benefit amounts automatically update when Medicare changes cost sharing amounts, such as
deductibles, coinsurance and copayments. NOT
Which definition best describes Medicare Part A?
The part of Medicare that is a voluntary program offered by private insurance companies that
provides prescription drug coverage for an additional monthly premium.
The part of Medicare that offers combined medical and prescription drug coverage.
The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with hospice
care and some skilled care for the homebound.
The part of Medicare that helps with the cost of medically necessary doctor visits and other medical
services, including outpatient care at hospitals and clinics, laboratory tests, some diagnostic
screenings. Correct Answers: The part of Medicare that helps with the cost of inpatient hospital stays.
It also helps with hospice care and some skilled care for the homebound.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a
Medicare Supplement Insurance Plan?
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically
disenrolled from his/her MA Plan.
A member does not need a valid election period to disenroll from an MA plan.
Questions And Answers
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare
helps cover the costs of his inpatient hospital stay? Correct Answers: Part A
Correct Answers: The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? Correct Answers: Consumers age
65 or older, consumers under 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? Correct Answers: MA Plans are
health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she
meet? (Select the two answers that apply.) Correct Answers: Not have End Stage Renal Disease
(permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA
Plan? (Select 3) Correct Answers:
Which of the following are MA Plans that focus on using network providers to maximize the benefits
and reduce out-of-network expenses? Correct Answers: HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment? Correct Answers: By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and enrolled in
Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? Correct Answers: The
OOP maximum is a feature that limits the amount of money a consumer will have to spend on
Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug Plan
(PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug
coverage? Correct Answers: The consumer will be automatically disenrolled from their stand-alone
PDP upon enrollment in the MA Plan that has integrated prescription drug coverage
A government program, offered only through a private insurance company or other private company
approved by Medicare, that provides prescription drug coverage describes which of the following:
Correct Answers: Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Prescription Drug
Plans? Correct Answers: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare
Part B
, What are two options for Medicare consumers to get Part D prescription drug coverage (assuming
they meet all eligibility requirements)? (Select 2) Correct Answers:
Which of the following statements is not true about the Coverage Gap? Correct Answers: All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) Correct
Answers:
Which of the following best describes the Late Enrollment Penalty (LEP)? Correct Answers: The
amount added to the member's monthly plan premium if they did not enroll 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 continuous
days or more.
Through which means is financial assistance offered to a consumer who qualifies for Low Income
Subsidy for their part of Medicare Part D costs? Correct Answers: Through subsidies such as lower
or no monthly plan premiums and lower or no copayments
Medications that are covered in a Plan's formulary have various levels of associated member cost-
sharing (copayments or coinsurance). What are these drug levels called? Correct Answers: Drug tiers
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following
underwriting criteria apply EXCEPT: Correct Answers: Consumers may be underwritten to determine
their acceptance and, if applicable, their rate.
The new MACRA legislation, which went into effect January 1, 2020, applies to all carriers offering
Medicare supplement plans. Correct Answers: TRUE
Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answers: Plan
benefit amounts automatically update when Medicare changes cost sharing amounts, such as
deductibles, coinsurance and copayments. NOT
Which definition best describes Medicare Part A?
The part of Medicare that is a voluntary program offered by private insurance companies that
provides prescription drug coverage for an additional monthly premium.
The part of Medicare that offers combined medical and prescription drug coverage.
The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with hospice
care and some skilled care for the homebound.
The part of Medicare that helps with the cost of medically necessary doctor visits and other medical
services, including outpatient care at hospitals and clinics, laboratory tests, some diagnostic
screenings. Correct Answers: The part of Medicare that helps with the cost of inpatient hospital stays.
It also helps with hospice care and some skilled care for the homebound.
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a
Medicare Supplement Insurance Plan?
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically
disenrolled from his/her MA Plan.
A member does not need a valid election period to disenroll from an MA plan.
