UHC certification Questions and Verified
Solutions
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
Solutions
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
