WELLCARE ACT MASTERY EXAM – BROKER QUESTIONS AND ANSWERS (VERIFIED AND WELL DETAILED ANSWERS) LATEST UPDATE 2025/2026

WELLCARE ACT MASTERY EXAM – BROKER QUESTIONS AND ANSWERS (VERIFIED AND WELL DETAILED ANSWERS) LATEST UPDATE 2025/2026 Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. True False - CORRECT ANS True The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be: (Select all that apply.) a. Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b. Verbally conveyed within the first minute of a sales call. c. Prominently displayed on TPMO websites (regardless of content). d. Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). - answer/ a. Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. b. Verbally conveyed within the first minute of a sales call. c. Prominently displayed on TPMO websites (regardless of content). d. Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). When a paper SOA form is used, it must be completed hosting the sales presentation. a. 48 Hours prior to b. During c. After - CORRECT ANS a. 48 Hours prior to When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid may affect enrollment and/or cost sharing. True False - CORRECT ANS True Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? a. Member Service b. Reputation c. Member Payments d. Serving Government Customers - CORRECT ANS c. Member Payments Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a. Ascend b. Telephonic c. Paper d. All of these - CORRECT ANS d. All of these Brokers/Agents can submit a support ticket online through their Centene Workbench portal. True False - CORRECT ANS True An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. True False - CORRECT ANS True *From October 1 to October 14, certain activities are Non-Permissible Activities. These include: a. Assist with completing an application b. Collect a completed application c. Advise the beneficiary to complete an application prior to October 15. d. All of these - CORRECT ANS d. All of these *NOT a. Assist with completing an application Ascend is a fast, easy, and compliant way for brokers/agents to submit agent- assisted electronic enrollments. True False - CORRECT ANS True Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. True False - CORRECT ANS False The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). True False - CORRECT ANS True Which elements are available as part of Wellcare's Sales Support model? a. Online b. Local c. Corporate d. All of these - CORRECT ANS d. All of these Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: a. Member Satisfaction/Experience b. Complaints c. Rapid Disenrollment d. All of these - CORRECT ANS d. All of these Which of the following is not an example of Protected Health Information (PHI)? a. Medical records b. Payment history c. Library card - CORRECT ANS c. Library card Which option is the preferred method to submit enrollment? a. Centene Workbench Upload b. Ascend Web/Mobile Application c. Fax/Paper - CORRECT ANS b. Ascend Web/Mobile Application With which types of inquiries can Wellcare's Corporate Sales Support team assist? a. Application and Enrollment b. Onboarding and Certifications c. Commissions d. All of these - CORRECT ANS d. All of these 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: a. Appeal b. Grievance - CORRECT ANS a. Appeal The Prescription Drug Plan (PDP) network is expected to include over total pharmacies. a. Sixty Thousand b. Thirty Thousand c. Twenty Thousand - CORRECT ANS a. Sixty Thousand With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. True False - CORRECT ANS False Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C. a. Two b. Three c. Four d. Five - CORRECT ANS d. Five Wellcare added which state to its footprint for 2024? a. Alabama b. Arkansas c. Delaware d. Oklahoma - CORRECT ANS c. Delaware *Wellcare's 2024 product expansion represents a % increase from 2023. a. One b. Two c. Three d. Five - CORRECT ANS c. Three * NOT c. Three The Wellcare preferred pharmacy network includes Walgreens, CVS, and some grocery chains in 2024. True False - CORRECT ANS True *Wellcare continues to expand its reach by offering more products in a wider geography. new Wellcare plans are going to market. a. Twenty-three b. Twenty-seven c. Thirty-five - CORRECT ANS b. Twenty-seven *NOT c. Thirty-five *Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? a. Classic b. Value Script c. Value Plus - CORRECT ANS a. Classic *NOT b. Value Script All Prescription Drug Plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. True False - CORRECT ANS True All Prescription Drug Plans (PDPs) will offer a $ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members. a. Zero b. Five c. Ten d. Fifteen - CORRECT ANS a. Zero Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted. True False - CORRECT ANS True *Wellcare's plan is designed for Low-Income Subsidy members. a. Classic b. Value Plus c. Value Script - CORRECT ANS a. Classic *NOT c. Value Script Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums. True False - CORRECT ANS False Enrollment applications must be received by Wellcare no later than calendar day(s) following receipt from the beneficiary. a. 1 b. 3 c. 5 d. 7 - CORRECT ANS a. 1 If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed. True False - CORRECT ANS True Once the enrollment is completed, you can save a copy of the application for your reference. True False - CORRECT ANS False Members who fail to pay the required premiums before the end of the grace period (Wellcare has a three-month grace period) will be terminated. True False - CORRECT ANS True When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. True False - CORRECT ANS The Mastery Exam will lock for a period of 48 hours after each failed attempt. True False - CORRECT ANS False CustomPoint sales material order dates will be posted on W. True False - CORRECT ANS False Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) a. Complaint Tracking Module (CTM) b. Yelp Review c. Grievance d. Secret Shop Finding - CORRECT ANS a. Complaint Tracking Module (CTM) c. Grievance d. Secret Shop Finding When explaining the provider network for D-SNPs and C-SNPs: (Select all that apply.) a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor. c. Not explaining the provider network is a fundamental task during the enrollment process. d. None of these - CORRECT ANS a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor. Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. True False - CORRECT ANS True 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. a. 30 b. 45 c. 60 d. 90 - CORRECT ANS c. 60 When discussing prescription drug coverage, you should: (Select all that apply.) a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c. Explain formulary tiers as well as drug copayment amounts. d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. - CORRECT ANS a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions. c. Explain formulary tiers as well as drug copayment amounts. d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? a. Speak with the investigator as quickly as possible. b. Answer all questions honestly and completely. c. Offer information and documents important to the investigation. d. All of these - CORRECT ANS d. All of these Which is an example of a top beneficiary complaint that affects Star Ratings? a. The beneficiary was enrolled in the correct plan. b. The provider was in-network and contracted with the selected plan. c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. d. The beneficiary enrolled by the enrollment deadline. - CORRECT ANS c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan. events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. a. Informal Sales b. Formal Sales c. Educational - CORRECT ANS c. Educational Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. True False - CORRECT ANS True Materials that include plan comparisons or cost-sharing do not require CMS submission. True False - CORRECT ANS False For Prescription Drug Plan (PDP) Medication Home Delivery, the plan will continue to offer a discount (2.5 x 30-day preferred retail copay) for Tier 2, 3, and 6 prescriptions. a. Classic b. Value Plus c. Value Script - CORRECT ANS b. Value Plus CVS Caremark Mail Order will be in-network for 2024. True False - CORRECT ANS False A Low-Income Subsidy (LIS) member will be assigned one of copay categories depending on the level of need. a. Two b. Three c. Four d. Five - CORRECT ANS c. Four Members are no longer required to pay a partial deductible due to the Inflation Reduction Act. True False - CORRECT ANS True Which Prescription Drug Plan (PDP) product features no deductible on any tier? a. Classic b. Value Script c. Value Plus - CORRECT ANS c. Value Plus