UHC CERTIFICATION 2 LATEST VERSIONS 2024-2025 ACTUAL EXAM 100 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility
requirements. - correct answerLisa turned 65 and is now eligible for Medicare. She already
receives Social Security benefits. How does she enroll in Original Medicare?
When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically
disenrolled from their MA Plan. - correct answerWhich statement is true about a member of a
Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?
Original Medicare - correct answerBeing 65 or older, being under 65 years of age with certain
disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility
requirements for which program?
1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer
additional benefits.
2. MA Plans provide Medicare hospital and medical insurance and often include Medicare
prescription drug coverage. - correct answerWhich of the following defines a Medicare
Advantage (MA) Plan? (Select 2)
Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) -
correct answerWhich of the following is NOT an eligibility requirement for enrollment in a
Medicare Advantage Plan?
Members must receive covered services from contracted network providers with limited
exceptions. - correct answerWhich of the following statements is correct about HMO MA
Plans?
(INCORRECT) Network-based MA plans have a provider network the member can use, and
some plans also cover certain services outside the network. - correct answerWhich of the
following is NOT a correct statement about in-network provider services?
(INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot
qualify for Medicare Supplement Open Enrollment.
(INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement
Insurance Plan. - correct answerWhat is true about Medicare supplement open enrollment?
The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B
services. - correct answerJennifer is enrolling into a Medicare Advantage (MA) plan and wants
to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate?
, UHC CERTIFICATION 2 LATEST VERSIONS 2024-2025 ACTUAL EXAM 100 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore,
after receiving confirmation of enrollment into the MA Plan, the member must cancel their
Medicare Supplement Insurance policy according to their carrier's rules. - correct answerWhich
of the following statements is true about a Medicare Supplement Insurance Plan member who
wants to enroll in an MA Plan?
It is a government program, offered only through a private insurance company or other private
company approved by Medicare, which provides prescription drug coverage. - correct
answerWhich of the following best defines Medicare Part D?
To enroll, member must be in plans service area - correct answerWhich of the following is a fact
about Medicare Prescription Drug Plans?
Enroll in a stand-alone Medicare Prescription Drug Plan (PDP)
Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage - correct answerWhat are two options for Medicare consumers to get Part D
prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2)
A deductible is the amount the member must pay for every prescription medication, regardless
of what stage they are in. - correct answerWhich of the following statements does NOT
correctly define prescription drug stages?
(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM
rules - correct answerWhich of these statements is NOT true about the drug utilization
management (UM) rules?
Late Enrollment Penalty (LEP) - correct answerWhat is 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 or more continuous days?
Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments
- correct answerCan a consumer who qualifies for Low Income Subsidy receive financial
assistance for their part of Medicare Part D costs?
A list of medications covered within the benefit plan, based on CMS guidelines and developed
in collaboration with physicians and pharmacists. - correct answerFormulary is defined as:
Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment
period or does not meet Guaranteed Issue criteria. - correct answerWhich of the following is
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility
requirements. - correct answerLisa turned 65 and is now eligible for Medicare. She already
receives Social Security benefits. How does she enroll in Original Medicare?
When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically
disenrolled from their MA Plan. - correct answerWhich statement is true about a member of a
Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?
Original Medicare - correct answerBeing 65 or older, being under 65 years of age with certain
disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility
requirements for which program?
1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer
additional benefits.
2. MA Plans provide Medicare hospital and medical insurance and often include Medicare
prescription drug coverage. - correct answerWhich of the following defines a Medicare
Advantage (MA) Plan? (Select 2)
Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) -
correct answerWhich of the following is NOT an eligibility requirement for enrollment in a
Medicare Advantage Plan?
Members must receive covered services from contracted network providers with limited
exceptions. - correct answerWhich of the following statements is correct about HMO MA
Plans?
(INCORRECT) Network-based MA plans have a provider network the member can use, and
some plans also cover certain services outside the network. - correct answerWhich of the
following is NOT a correct statement about in-network provider services?
(INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot
qualify for Medicare Supplement Open Enrollment.
(INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement
Insurance Plan. - correct answerWhat is true about Medicare supplement open enrollment?
The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B
services. - correct answerJennifer is enrolling into a Medicare Advantage (MA) plan and wants
to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate?
, UHC CERTIFICATION 2 LATEST VERSIONS 2024-2025 ACTUAL EXAM 100 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore,
after receiving confirmation of enrollment into the MA Plan, the member must cancel their
Medicare Supplement Insurance policy according to their carrier's rules. - correct answerWhich
of the following statements is true about a Medicare Supplement Insurance Plan member who
wants to enroll in an MA Plan?
It is a government program, offered only through a private insurance company or other private
company approved by Medicare, which provides prescription drug coverage. - correct
answerWhich of the following best defines Medicare Part D?
To enroll, member must be in plans service area - correct answerWhich of the following is a fact
about Medicare Prescription Drug Plans?
Enroll in a stand-alone Medicare Prescription Drug Plan (PDP)
Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage - correct answerWhat are two options for Medicare consumers to get Part D
prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2)
A deductible is the amount the member must pay for every prescription medication, regardless
of what stage they are in. - correct answerWhich of the following statements does NOT
correctly define prescription drug stages?
(INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM
rules - correct answerWhich of these statements is NOT true about the drug utilization
management (UM) rules?
Late Enrollment Penalty (LEP) - correct answerWhat is 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 or more continuous days?
Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments
- correct answerCan a consumer who qualifies for Low Income Subsidy receive financial
assistance for their part of Medicare Part D costs?
A list of medications covered within the benefit plan, based on CMS guidelines and developed
in collaboration with physicians and pharmacists. - correct answerFormulary is defined as:
Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment
period or does not meet Guaranteed Issue criteria. - correct answerWhich of the following is
