UHC 24 DUAL AND CHRONIC PLANS EXAM QUESTIONS
AND CORRECT ANSWERS| ACCURATE REAL EXAM WITH
FREQUENTLY TESTED QUESTIONS AND
RATIONALE|ALREADY A GRADED|GUARANTEED
PASS|LATEST UPDATE 2025.
On July 19, each of the following consumers met with an agent. Based on the information
provided, which consumer must wait until the Annual Election Period (AEP) or Open
Enrollment Period (OEP) to enroll? - CORRECT ANSWER Joy has a cardiovascular disorder,
is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by
the plan that covers the same condition.
Which service will a CSNP or DSNP member in the high risk care management category
receive? - CORRECT ANSWER Case Management (telephonic, digital and/or face-to-face)
according to individual needs
What is the purpose of the Chronic Condition Verification form? - CORRECT ANSWER It
authorizes the plan to contact the provider identified on the form in order to verify that the
consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Alice is enrolling in a DSNP. What should her agent remind her about? - CORRECT ANSWER
She is not required to pay copayments for Medicare-covered services when she uses a provider
in the DSNP network because she is Full Dual Eligible. Her provider should bill the state
Medicaid program, as appropriate, for these costs.
The three types of Special Needs Plans are: - CORRECT ANSWER Dual, Chronic Condition
and Institutional/Institutional-Equivalent.
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER The month after they are notified by the
plan of the loss of Medicaid eligibility
A DSNP might be in the best interest of which of these consumers? - CORRECT ANSWER Joe,
whose low income qualifies him for full Medicaid coverage
Which program is available to support the unique health care needs of CSNP and DSNP
members? - CORRECT ANSWER A care management program that varies depending upon the
level of the member's health risk level
Which statement best describes a DSNP? - CORRECT ANSWER The monthly premium is at or
below the Low Income Subsidy benchmark to cover drug costs
When selling DSNPs, agents must: - CORRECT ANSWER Ensure that the consumer only has
Medicare
Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and
enrolled in Part B
,Which consumer may be a good candidate for a DSNP? - CORRECT ANSWER Anne, who
does not pay a percentage of charges when she receives medical care
Which of the following consumers is best suited for a CSNP? - CORRECT ANSWER Mary,
who has been seeing a specialist for a qualifying chronic condition
On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due
to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only
chronic condition), assuming he has not moved out of his current plan's service area? -
CORRECT ANSWER During the Annual Election Period (AEP) or Open Enrollment Period
(OEP)
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care
management risk level? - CORRECT ANSWER Ongoing reassessment of risk level for status
changes
What is the purpose of the Chronic Condition Verification form? - CORRECT ANSWER It
authorizes the plan to contact the provider identified on the form in order to verify that the
consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Which statement is true about the Medicaid program? - CORRECT ANSWER It helps pay
medical costs for certain groups of people with limited income and resources.
Which statement is true of DSNP members? - CORRECT ANSWER Members who are QMB+
or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services
obtained from a DSNP in-network provider.
How long do plans using the CSNP pre-enrollment verification process have to verify the
qualifying chronic condition until they must deny the enrollment request? - CORRECT
ANSWER Within 21 days of the request for additional information or the end of the month in
which the enrollment request is made (whichever is longer).
Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the
DSNP in which she is enrolled. What is her responsibility for cost sharing? - CORRECT
ANSWER All, such as premiums, deductibles, copayments, and coinsurance
Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? -
CORRECT ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for
DSNP members that lose their Medicaid eligibility.
Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - CORRECT
ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A
and enrolled in Medicare Part B is a requirement of: - CORRECT ANSWER Selling DSNPs
,Which of the following consumers may not be a good candidate for a DSNP? - CORRECT
ANSWER Maria, who pays a percentage of charges when she receives medical care
How is a CSNP or DSNP member's care management health risk levels determined initially? -
CORRECT ANSWER The member completes a Health Assessment that asks a series of
questions about their health status and assistance they may need with activities of daily living.
Dual Special Needs Plans (DSNP) are defined as which of the following: - CORRECT
ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both
Medicare and Medicaid
Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? -
CORRECT ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for
DSNP members that lose their Medicaid eligibility.
Which consumer might benefit the most by enrolling in a DSNP? - CORRECT ANSWER Joe,
who receives Qualified Medicaid Beneficiary benefits (QMB+)
What program is available to support CSNP and DSNP members who may have unique health
care needs? - CORRECT ANSWER A care management program that varies depending upon
the level of the member's health risk level
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A
and enrolled in Medicare Part B is a requirement of: - CORRECT ANSWER Selling DSNPs
The consumer states they currently pay a percentage of charges when they receive medical care.
This means: - CORRECT ANSWER The consumer is not likely to be a Full Dual-Eligible and
may be better suited for enrollment in another type of plan.
Which of the following consumer characteristics demonstrates a good fit for a CSNP? -
CORRECT ANSWER A consumer with a qualifying chronic condition who wants a plan that
will help them manage their illness and health care costs
On July 19, each of the following consumers met with an agent. Based on the information
provided, which consumer must wait until the Annual Election Period (AEP) or Open
Enrollment Period (OEP) to enroll? - CORRECT ANSWER Joy has a cardiovascular disorder,
is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by
the plan that covers the same condition.
Which service will a CSNP or DSNP member in the high risk care management category
receive? - CORRECT ANSWER Case Management (telephonic, digital and/or face-to-face)
according to individual needs
It is very important for consumers enrolling in a CSNP to know the following about accessing
providers: - CORRECT ANSWER Some CSNPs are Preferred Provider Organization (PPO) or
, Point of Service (POS) Plans that allow members to see out-of-network providers, generally with
higher cost sharing.
Which statement is true about the Medicaid program? - CORRECT ANSWER It helps pay
medical costs for certain groups of people with limited income and resources.
You must advise consumers enrolling in a DSNP that: - CORRECT ANSWER They are not
required to pay copayments for Medicare-covered services received from a DSNP network
provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with
the state in which they reside. Their provider should bill the state Medicaid program.
Ginny just enrolled in a CSNP that uses the post-enrollment verification method. When will the
plan send her a termination notification letter if it has not yet been able to verify a qualifying
chronic condition? - CORRECT ANSWER At the end of her first month of enrollment
A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost
sharing is he responsible for while in the grace period? - CORRECT ANSWER All, such as
premiums, deductibles, copayments, and coinsurance
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER Upon notification or effective date of the
loss, whichever is earlier
Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - CORRECT
ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage
When selling DSNPs, agents must: - CORRECT ANSWER Confirm the consumer's Medicaid
level and that the consumer is entitled to Medicare Part A and enrolled in Part B
Dual Special Needs Plans (DSNP) are defined as which of the following: - CORRECT
ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both
Medicare and Medicaid
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER Upon notification or effective date of the
loss, whichever is earlier
A DSNP might be in the best interest of which of these consumers? - CORRECT ANSWER Joe,
whose low income qualifies him for full Medicaid coverage
Which statement best describes a care management program that varies depending upon the level
of the member's health risk? - CORRECT ANSWER Support provided to CSNP and DSNP
members that may have unique health care needs
Select the statement that best describes a feature of DSNPs. - CORRECT ANSWER NOT
***********A member can see any participating Medicaid provider
AND CORRECT ANSWERS| ACCURATE REAL EXAM WITH
FREQUENTLY TESTED QUESTIONS AND
RATIONALE|ALREADY A GRADED|GUARANTEED
PASS|LATEST UPDATE 2025.
On July 19, each of the following consumers met with an agent. Based on the information
provided, which consumer must wait until the Annual Election Period (AEP) or Open
Enrollment Period (OEP) to enroll? - CORRECT ANSWER Joy has a cardiovascular disorder,
is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by
the plan that covers the same condition.
Which service will a CSNP or DSNP member in the high risk care management category
receive? - CORRECT ANSWER Case Management (telephonic, digital and/or face-to-face)
according to individual needs
What is the purpose of the Chronic Condition Verification form? - CORRECT ANSWER It
authorizes the plan to contact the provider identified on the form in order to verify that the
consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Alice is enrolling in a DSNP. What should her agent remind her about? - CORRECT ANSWER
She is not required to pay copayments for Medicare-covered services when she uses a provider
in the DSNP network because she is Full Dual Eligible. Her provider should bill the state
Medicaid program, as appropriate, for these costs.
The three types of Special Needs Plans are: - CORRECT ANSWER Dual, Chronic Condition
and Institutional/Institutional-Equivalent.
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER The month after they are notified by the
plan of the loss of Medicaid eligibility
A DSNP might be in the best interest of which of these consumers? - CORRECT ANSWER Joe,
whose low income qualifies him for full Medicaid coverage
Which program is available to support the unique health care needs of CSNP and DSNP
members? - CORRECT ANSWER A care management program that varies depending upon the
level of the member's health risk level
Which statement best describes a DSNP? - CORRECT ANSWER The monthly premium is at or
below the Low Income Subsidy benchmark to cover drug costs
When selling DSNPs, agents must: - CORRECT ANSWER Ensure that the consumer only has
Medicare
Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and
enrolled in Part B
,Which consumer may be a good candidate for a DSNP? - CORRECT ANSWER Anne, who
does not pay a percentage of charges when she receives medical care
Which of the following consumers is best suited for a CSNP? - CORRECT ANSWER Mary,
who has been seeing a specialist for a qualifying chronic condition
On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due
to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only
chronic condition), assuming he has not moved out of his current plan's service area? -
CORRECT ANSWER During the Annual Election Period (AEP) or Open Enrollment Period
(OEP)
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care
management risk level? - CORRECT ANSWER Ongoing reassessment of risk level for status
changes
What is the purpose of the Chronic Condition Verification form? - CORRECT ANSWER It
authorizes the plan to contact the provider identified on the form in order to verify that the
consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Which statement is true about the Medicaid program? - CORRECT ANSWER It helps pay
medical costs for certain groups of people with limited income and resources.
Which statement is true of DSNP members? - CORRECT ANSWER Members who are QMB+
or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services
obtained from a DSNP in-network provider.
How long do plans using the CSNP pre-enrollment verification process have to verify the
qualifying chronic condition until they must deny the enrollment request? - CORRECT
ANSWER Within 21 days of the request for additional information or the end of the month in
which the enrollment request is made (whichever is longer).
Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the
DSNP in which she is enrolled. What is her responsibility for cost sharing? - CORRECT
ANSWER All, such as premiums, deductibles, copayments, and coinsurance
Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? -
CORRECT ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for
DSNP members that lose their Medicaid eligibility.
Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - CORRECT
ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A
and enrolled in Medicare Part B is a requirement of: - CORRECT ANSWER Selling DSNPs
,Which of the following consumers may not be a good candidate for a DSNP? - CORRECT
ANSWER Maria, who pays a percentage of charges when she receives medical care
How is a CSNP or DSNP member's care management health risk levels determined initially? -
CORRECT ANSWER The member completes a Health Assessment that asks a series of
questions about their health status and assistance they may need with activities of daily living.
Dual Special Needs Plans (DSNP) are defined as which of the following: - CORRECT
ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both
Medicare and Medicaid
Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? -
CORRECT ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for
DSNP members that lose their Medicaid eligibility.
Which consumer might benefit the most by enrolling in a DSNP? - CORRECT ANSWER Joe,
who receives Qualified Medicaid Beneficiary benefits (QMB+)
What program is available to support CSNP and DSNP members who may have unique health
care needs? - CORRECT ANSWER A care management program that varies depending upon
the level of the member's health risk level
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A
and enrolled in Medicare Part B is a requirement of: - CORRECT ANSWER Selling DSNPs
The consumer states they currently pay a percentage of charges when they receive medical care.
This means: - CORRECT ANSWER The consumer is not likely to be a Full Dual-Eligible and
may be better suited for enrollment in another type of plan.
Which of the following consumer characteristics demonstrates a good fit for a CSNP? -
CORRECT ANSWER A consumer with a qualifying chronic condition who wants a plan that
will help them manage their illness and health care costs
On July 19, each of the following consumers met with an agent. Based on the information
provided, which consumer must wait until the Annual Election Period (AEP) or Open
Enrollment Period (OEP) to enroll? - CORRECT ANSWER Joy has a cardiovascular disorder,
is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by
the plan that covers the same condition.
Which service will a CSNP or DSNP member in the high risk care management category
receive? - CORRECT ANSWER Case Management (telephonic, digital and/or face-to-face)
according to individual needs
It is very important for consumers enrolling in a CSNP to know the following about accessing
providers: - CORRECT ANSWER Some CSNPs are Preferred Provider Organization (PPO) or
, Point of Service (POS) Plans that allow members to see out-of-network providers, generally with
higher cost sharing.
Which statement is true about the Medicaid program? - CORRECT ANSWER It helps pay
medical costs for certain groups of people with limited income and resources.
You must advise consumers enrolling in a DSNP that: - CORRECT ANSWER They are not
required to pay copayments for Medicare-covered services received from a DSNP network
provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with
the state in which they reside. Their provider should bill the state Medicaid program.
Ginny just enrolled in a CSNP that uses the post-enrollment verification method. When will the
plan send her a termination notification letter if it has not yet been able to verify a qualifying
chronic condition? - CORRECT ANSWER At the end of her first month of enrollment
A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost
sharing is he responsible for while in the grace period? - CORRECT ANSWER All, such as
premiums, deductibles, copayments, and coinsurance
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER Upon notification or effective date of the
loss, whichever is earlier
Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - CORRECT
ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage
When selling DSNPs, agents must: - CORRECT ANSWER Confirm the consumer's Medicaid
level and that the consumer is entitled to Medicare Part A and enrolled in Part B
Dual Special Needs Plans (DSNP) are defined as which of the following: - CORRECT
ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both
Medicare and Medicaid
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members
that lose Medicaid eligibility? - CORRECT ANSWER Upon notification or effective date of the
loss, whichever is earlier
A DSNP might be in the best interest of which of these consumers? - CORRECT ANSWER Joe,
whose low income qualifies him for full Medicaid coverage
Which statement best describes a care management program that varies depending upon the level
of the member's health risk? - CORRECT ANSWER Support provided to CSNP and DSNP
members that may have unique health care needs
Select the statement that best describes a feature of DSNPs. - CORRECT ANSWER NOT
***********A member can see any participating Medicaid provider
