UHC CERTIFICATION EXAM QUESTIONS
WITH COMPLETE ANSWERS
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 doesn’t 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 additional 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 referrals? - Answer-Yes
, Do PPO's require a referral? - Answer-No
When a member enrols 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 maximum annual limit on OOP costs called a? - Answer-MOOP
amount (Maximum 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 exists for MA-only PFFS plans as a member can also be enrolled in a
what? - Answer-Stand alone PDP
If a member enrols 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 enrols 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
WITH COMPLETE ANSWERS
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 doesn’t 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 additional 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 referrals? - Answer-Yes
, Do PPO's require a referral? - Answer-No
When a member enrols 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 maximum annual limit on OOP costs called a? - Answer-MOOP
amount (Maximum 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 exists for MA-only PFFS plans as a member can also be enrolled in a
what? - Answer-Stand alone PDP
If a member enrols 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 enrols 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
