WELLCARE ACT MASTERY TEST PAPER 2025 QUESTIONS
WITH SOLUTIONS GUARANTEE A+
✔✔Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part
D plan premiums. - ✔✔FALSE
✔✔When completing an application, you should ensure that you enter the provider ID of
a specialist and not a primary care provider (PCP). - ✔✔FALSE
✔✔Best practices to keep in mind for Dual Eligible Special Needs Plan (D-SNP) and
Chronic Condition Special Needs Plan (C-SNP) enrollments include the following:
(Select all that apply.) - ✔✔-If a member is not connected to a primary care provider
(PCP), always encourage and assist with connecting them to an in-network doctor.
- Avoid submitting applications with no PCP to assist these higher-risk members.
✔✔Failure to inform a beneficiary that a trusted provider is out-of-network or is not
available in the newly selected plan can cause a sales allegatio - ✔✔TRUE
✔✔Which of the following statements about completing telephonic enrollments is
FALSE? - ✔✔Must include some of the required elements necessary to complete the
enrollment.
✔✔Names and/or logos of provider co-branding partners can be displayed on marketing
materials, as long as the current and approved logos are used. - ✔✔FALSE
✔✔Upon completion of the application, you must provide the beneficiary with the
enrollment application confirmation ID. - ✔✔TRUE
✔✔When completing enrollments, be sure to collect the member's ____ and ____ to
help ensure they receive important resources throughout and beyond their onboarding
journey. - ✔✔Email address
Mobile phone number
✔✔A request to the plan from a member or provider for a formal review of an Action
(Denial) or Adverse Plan Determination (Medicare) is a/an: - ✔✔Appeal
✔✔Grievance procedures are separate and distinct from initial determination and
appeal procedures. - ✔✔TRUE
✔✔The Pre-Enrollment Checklist (PECL) should be provided and reviewed with the
prospective enrollee after enrollment to ensure the enrollee understands important plan
benefits and rules. - ✔✔FALSE
, ✔✔A grievance request, or any evidence concerning a grievance, must be filed orally or
in writing no later than _____ calendar days from the date of the event or the date the
member is made aware of the issue. - ✔✔60
✔✔Key areas you as an agent have control over and impact upon regarding Star
Ratings for quality are: - ✔✔All of these
✔✔Which of the following is not an example of Protected Health Information (PHI)? -
✔✔Library card
✔✔The Medicare Prescription Payment Plan is a payment option that helps manage
out-of-pocket (OOP) Part B costs by allowing members who opt-in to spread costs
throughout the benefit year. - ✔✔TRUE
✔✔Starting in 2025, a member may move through THREE benefit stages during the
plan year. Which benefit stage will no longer exist? - ✔✔Coverage gap
✔✔The Pre-Enrollment Checklist (PECL) should be provided and reviewed with your
client after enrollment to ensure the enrollee understands important plan benefits and
rules. - ✔✔FALSE
✔✔The Medicare Prescription Payment Plan allows prescription costs to be spread
across _____ payments billed directly to the member. - ✔✔Monthly
✔✔For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plans will
continue to offer a discount (2.5 x 30-day preferred retail copay) for a 90-day supply of
Tier 2 medications. - ✔✔Value Plus
✔✔For 2025, Wellcare will offer a Value-Based Insurance Design (VBID) model on
select Dual Eligible Special Needs Plans (D-SNPs) that include $0 deductible and $0
copays for covered prescriptions. - ✔✔TRUE
✔✔Many of our Medicare Advantage (MA) plans offer supplemental benefits above and
beyond what is offered on Original Medicare. Examples include: (Select all that apply) -
✔✔Meals
Transportation
Over-the-counter (OTC) items and medications
✔✔All Prescription Drug Plans (PDPs) offer preferred cost-sharing including $0 copay
on Tier 1 preferred generic medications through Express Scripts Pharmacy home
delivery. - ✔✔TRUE
WITH SOLUTIONS GUARANTEE A+
✔✔Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part
D plan premiums. - ✔✔FALSE
✔✔When completing an application, you should ensure that you enter the provider ID of
a specialist and not a primary care provider (PCP). - ✔✔FALSE
✔✔Best practices to keep in mind for Dual Eligible Special Needs Plan (D-SNP) and
Chronic Condition Special Needs Plan (C-SNP) enrollments include the following:
(Select all that apply.) - ✔✔-If a member is not connected to a primary care provider
(PCP), always encourage and assist with connecting them to an in-network doctor.
- Avoid submitting applications with no PCP to assist these higher-risk members.
✔✔Failure to inform a beneficiary that a trusted provider is out-of-network or is not
available in the newly selected plan can cause a sales allegatio - ✔✔TRUE
✔✔Which of the following statements about completing telephonic enrollments is
FALSE? - ✔✔Must include some of the required elements necessary to complete the
enrollment.
✔✔Names and/or logos of provider co-branding partners can be displayed on marketing
materials, as long as the current and approved logos are used. - ✔✔FALSE
✔✔Upon completion of the application, you must provide the beneficiary with the
enrollment application confirmation ID. - ✔✔TRUE
✔✔When completing enrollments, be sure to collect the member's ____ and ____ to
help ensure they receive important resources throughout and beyond their onboarding
journey. - ✔✔Email address
Mobile phone number
✔✔A request to the plan from a member or provider for a formal review of an Action
(Denial) or Adverse Plan Determination (Medicare) is a/an: - ✔✔Appeal
✔✔Grievance procedures are separate and distinct from initial determination and
appeal procedures. - ✔✔TRUE
✔✔The Pre-Enrollment Checklist (PECL) should be provided and reviewed with the
prospective enrollee after enrollment to ensure the enrollee understands important plan
benefits and rules. - ✔✔FALSE
, ✔✔A grievance request, or any evidence concerning a grievance, must be filed orally or
in writing no later than _____ calendar days from the date of the event or the date the
member is made aware of the issue. - ✔✔60
✔✔Key areas you as an agent have control over and impact upon regarding Star
Ratings for quality are: - ✔✔All of these
✔✔Which of the following is not an example of Protected Health Information (PHI)? -
✔✔Library card
✔✔The Medicare Prescription Payment Plan is a payment option that helps manage
out-of-pocket (OOP) Part B costs by allowing members who opt-in to spread costs
throughout the benefit year. - ✔✔TRUE
✔✔Starting in 2025, a member may move through THREE benefit stages during the
plan year. Which benefit stage will no longer exist? - ✔✔Coverage gap
✔✔The Pre-Enrollment Checklist (PECL) should be provided and reviewed with your
client after enrollment to ensure the enrollee understands important plan benefits and
rules. - ✔✔FALSE
✔✔The Medicare Prescription Payment Plan allows prescription costs to be spread
across _____ payments billed directly to the member. - ✔✔Monthly
✔✔For Prescription Drug Plan (PDP) Medication Home Delivery, the ____ plans will
continue to offer a discount (2.5 x 30-day preferred retail copay) for a 90-day supply of
Tier 2 medications. - ✔✔Value Plus
✔✔For 2025, Wellcare will offer a Value-Based Insurance Design (VBID) model on
select Dual Eligible Special Needs Plans (D-SNPs) that include $0 deductible and $0
copays for covered prescriptions. - ✔✔TRUE
✔✔Many of our Medicare Advantage (MA) plans offer supplemental benefits above and
beyond what is offered on Original Medicare. Examples include: (Select all that apply) -
✔✔Meals
Transportation
Over-the-counter (OTC) items and medications
✔✔All Prescription Drug Plans (PDPs) offer preferred cost-sharing including $0 copay
on Tier 1 preferred generic medications through Express Scripts Pharmacy home
delivery. - ✔✔TRUE
