Uhc Certification Actual Exam Questions & Correct, Certified Solutions, 2025/2026.

UHC CERTIFICATION ACTUAL
EXAM QUESTIONS & CORRECT, CERTIFIED
SOLUTIONS, 2025/2026.

Medicare - CORRECT ANSWER -Federal health insurance program



Medicare is administered by whom? - CORRECT ANSWER -CMS ( Centers for medicare and
medicaid services)



Parts A & B of medicare are - CORRECT ANSWER -federal health insurance program
referred to as original medicare



Part A? - CORRECT ANSWER -Hospital insurance



Part B? - CORRECT ANSWER -Medical insurance



What doesnt medicare cover? - CORRECT ANSWER -routine dental, eye care hearing
exam,deductibles, coinsurance and copayments



Part C? - CORRECT ANSWER -Medicare Advantage Plans



MA covers? - CORRECT ANSWER -Part A &B coverage, and some part D coverage



MA plans are not? - CORRECT ANSWER -Medicare supplement insurance plans



What offers lower monthly premiums MADP or supplement? - CORRECT 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? - CORRECT ANSWER -YES



MA plans integrate what type of additonal coverage? - CORRECT 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? - CORRECT ANSWER -MA-only PFFS plan



What is a stand alone drug plan called? - CORRECT ANSWER -PDP



WHat is PFFS? - CORRECT 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? - CORRECT ANSWER -PFFS
plan



Do HMO's require referals? - CORRECT ANSWER -Yes



Do PPO's require a referal? - CORRECT ANSWER -No



When a member enrolls in a MA plan, they receive their coverage from medicare or the MA
plan? - CORRECT ANSWER -MA plan



When a customer is enrolled in a MA plan, they must continue paying their premiums for
what other plan? - CORRECT ANSWER -Part B



MA plans have a maxium annual limit on OOP costs called a? - CORRECT 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_____? - CORRECT ANSWER -effective date



An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? -
CORRECT ANSWER -Stand alone PDP



If a member enrolls in a MA plan, what must the member do? - CORRECT 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? - CORRECT ANSWER -MA plan



A medicare supplement insurance plan helps to cover some of the OOP costs associated
with? - CORRECT ANSWER -original medicare.



A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan?
- CORRECT ANSWER -MA plan



when a client enrolls in a MA plan, will it automatically terminate their MA plan? - CORRECT
ANSWER -NO



Can a customer call to terminate their Med Sup plan? - CORRECT ANSWER -no it must be
done in writing



What are the different types of MA plans? - CORRECT 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? - CORRECT ANSWER -Emergencies, Urgent care, and renal dialysis services.