UHC Certification Exam Questions & 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? - Part A - The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - 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? - 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.) - 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) - Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? - HMO, POS, PPO Which is true about Medicare Supplement Open Enrollment? - 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? - 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? - The consumer will be automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverageA 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: - Medicare Parts A and B Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? - 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) - Which of the following statements is not true about the Coverage Gap? - All members reach the Coverage Gap Which of the following options are drug utilization management (UM) rules? (Select 3) - Which of the following best describes the Late Enrollment Penalty (LEP)? - 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? - 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? - Drug tiers In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following underwriting criteria apply EXCEPT: - 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. - TRUE