UHC MEDICARE CERTIFICATION NEWEST ACTUAL
COMPLETE Over 200 QUESTIONS WITH DETAILED &
VERIFIED ANSWERS 2025./2026
UHC MEDICARE CERTIFICATION NEWEST ACTUAL
COMPLETE Over 200 QUESTIONS WITH DETAILED &
VERIFIED ANSWERS 2025./2026
1. **What does CMS stand for? What is the difference between Medicare and
Medicaid?**
*CMS = Centers for Medicare and Medicaid. Medicare is the federal program run by the
Department of Health and Human Services, and Medicaid is managed more at the state
level.*
2. **Describe the history of Medicare.**
*On July 30, 1965, President Lyndon Johnson signed a law that led to both Medicare
and Medicaid programs. This was a federal health care plan for the poor—seniors were
the population most likely to be living in poverty. The federal agency became the
Centers for Medicare and Medicaid Services (CMS).*
3. **When was Medicare coverage expanded? Who was it expanded to?**
*Medicare coverage was expanded in 1972 to cover individuals under age 65 with long-
term disabilities and people with ESRD.*
4. **Who is the CMS Administrator appointed by?**
*The CMS administrator is appointed by the President of the United States.*
5. **What are the responsibilities of the CMS administrator?**
,*The CMS administrator oversees a $1 trillion budget, which is 26% of the total federal
budget. Responsibilities include directing planning, coordination, and implementation of
programs; overseeing establishment of program goals and objectives; overseeing
development of policies, standards, and guidelines; evaluating progress in
administration of CMS programs; and ensuring required actions are taken to achieve
program objectives.*
6. **Who was the CMS Administrator under the Trump Administration and when did she
resign?**
*Seema Verma - she resigned on January 15, 2021.*
7. **Who will be the CMS administrator under the Biden administration?**
*Elizabeth Richter is the interim administrator. Chiquita Brooks-LaSure and Mandy
Cohen are currently the leading candidates.*
8. **What criteria does an individual need to meet to be eligible for Medicare at age 65
or older?**
*To receive full Medicare benefits at age 65 or older, an individual needs to meet the
following requirements: U.S. citizen or permanent legal resident who lived in the U.S. for
at least five years; and an individual or spouse has worked long enough to be eligible
for SS or railroad retirement benefits (usually having earned 40 credits over 10 years of
work); or individual or spouse is a government employee or retiree who has not paid SS
but paid Medicare payroll taxes while working.*
9. **What does earning 40 credits through payroll taxes guarantee?**
*Earning 40 credits through payroll taxes guarantees that the individual will not have to
pay premiums for Part A benefits.*
10. **What criteria does an individual need to meet to be eligible for Medicare under age
65?**
*To receive full Medicare benefits under age 65, an individual needs to meet the
following requirements: entitled to SS disability benefits for at least 24 months that need
not be consecutive; or receive disability pension from Railroad Retirement Board and
,meet certain conditions; or have Lou Gehrig's disease (ALS); or have permanent kidney
failure requiring regular dialysis or a kidney transplant, and individual or spouse had
paid SS taxes for a specified length of time depending on the person's age.*
11. **What is the National Quality Strategy (NQS)?**
*The NQS was first published in March 2011 as a National Strategy for Quality
Improvement in Health Care. It was led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). It is
updated annually in a report to Congress. The report articulates broad aims and
priorities guiding CMS programs, regulations, and initiatives.*
12. **What was one of the objectives of CMS?**
*"CMS, in collaboration with public and private partners, is transforming how we conduct
business and operations, connect providers, and empower consumers and
beneficiaries. We are working to build a healthcare delivery system that is better,
smarter, and healthier—a system that delivers improved care, spends healthcare dollars
more wisely, and makes our communities healthier."*
13. **What is the CMS Quality Strategy?**
*The CMS quality strategy includes aims to provide better, more affordable care, and
priorities to guide efforts to improve health and healthcare quality.*
14. **What are the three aims of the CMS Quality Strategy?**
*1. Better Care: Improve the overall quality of care by making healthcare more person-
centered, reliable, accessible, and safe.*
*2. Healthier People, Healthier Communities: Improve the health of Americans by
supporting proven interventions to address behavioral, social, and environmental
determinants of health, and deliver higher-quality care.*
*3. Smarter Spending: Reduce the cost of quality healthcare for individuals, families,
employers, government, and communities.*
15. **What are the six priorities of the CMS Quality Strategy?**
, *1. Make Care Safer by Reducing Harm Caused in the Delivery of Care*
*2. Strengthen Person and Family Engagement as Partners in Their Care*
*3. Promote Effective Communication and Coordination of Care*
*4. Promote Effective Prevention and Treatment of Chronic Disease*
*5. Work with Communities to Promote Best Practices of Healthy Living*
*6. Make Care Affordable*
16. **What are the four parts to Medicare? What is included in each part?**
*Part A: inpatient hospital care, skilled nursing services, hospice care (acute care)*
*Part B: doctor’s visits, outpatient hospital services, durable medical equipment,
physician-administered drugs*
*Part C: Medicare Advantage plans, which combine parts A & B; may cover vision,
dental, and hearing*
*Part D: prescription drug coverage*
17. **What is included under hospital coverage for Medicare Part A?**
*Inpatient/acute hospital care, surgery, skilled nursing services (SNFs), laboratory tests,
home health visits, hospice services*
18. **What is the yearly deductible for Medicare Part A?**
*$1,484 for 2021. This deductible covers costs for the first 60 days of inpatient hospital
stay. The beneficiary needs a supplemental policy to assist after day 61.*
19. **Describe Acute Care Hospitals (ACHs) under Medicare Part A coverage.**
*Short-term inpatient care requiring a 2-midnight stay to qualify for Part A payment.*
20. **How is an acute care hospital reimbursed?**
COMPLETE Over 200 QUESTIONS WITH DETAILED &
VERIFIED ANSWERS 2025./2026
UHC MEDICARE CERTIFICATION NEWEST ACTUAL
COMPLETE Over 200 QUESTIONS WITH DETAILED &
VERIFIED ANSWERS 2025./2026
1. **What does CMS stand for? What is the difference between Medicare and
Medicaid?**
*CMS = Centers for Medicare and Medicaid. Medicare is the federal program run by the
Department of Health and Human Services, and Medicaid is managed more at the state
level.*
2. **Describe the history of Medicare.**
*On July 30, 1965, President Lyndon Johnson signed a law that led to both Medicare
and Medicaid programs. This was a federal health care plan for the poor—seniors were
the population most likely to be living in poverty. The federal agency became the
Centers for Medicare and Medicaid Services (CMS).*
3. **When was Medicare coverage expanded? Who was it expanded to?**
*Medicare coverage was expanded in 1972 to cover individuals under age 65 with long-
term disabilities and people with ESRD.*
4. **Who is the CMS Administrator appointed by?**
*The CMS administrator is appointed by the President of the United States.*
5. **What are the responsibilities of the CMS administrator?**
,*The CMS administrator oversees a $1 trillion budget, which is 26% of the total federal
budget. Responsibilities include directing planning, coordination, and implementation of
programs; overseeing establishment of program goals and objectives; overseeing
development of policies, standards, and guidelines; evaluating progress in
administration of CMS programs; and ensuring required actions are taken to achieve
program objectives.*
6. **Who was the CMS Administrator under the Trump Administration and when did she
resign?**
*Seema Verma - she resigned on January 15, 2021.*
7. **Who will be the CMS administrator under the Biden administration?**
*Elizabeth Richter is the interim administrator. Chiquita Brooks-LaSure and Mandy
Cohen are currently the leading candidates.*
8. **What criteria does an individual need to meet to be eligible for Medicare at age 65
or older?**
*To receive full Medicare benefits at age 65 or older, an individual needs to meet the
following requirements: U.S. citizen or permanent legal resident who lived in the U.S. for
at least five years; and an individual or spouse has worked long enough to be eligible
for SS or railroad retirement benefits (usually having earned 40 credits over 10 years of
work); or individual or spouse is a government employee or retiree who has not paid SS
but paid Medicare payroll taxes while working.*
9. **What does earning 40 credits through payroll taxes guarantee?**
*Earning 40 credits through payroll taxes guarantees that the individual will not have to
pay premiums for Part A benefits.*
10. **What criteria does an individual need to meet to be eligible for Medicare under age
65?**
*To receive full Medicare benefits under age 65, an individual needs to meet the
following requirements: entitled to SS disability benefits for at least 24 months that need
not be consecutive; or receive disability pension from Railroad Retirement Board and
,meet certain conditions; or have Lou Gehrig's disease (ALS); or have permanent kidney
failure requiring regular dialysis or a kidney transplant, and individual or spouse had
paid SS taxes for a specified length of time depending on the person's age.*
11. **What is the National Quality Strategy (NQS)?**
*The NQS was first published in March 2011 as a National Strategy for Quality
Improvement in Health Care. It was led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). It is
updated annually in a report to Congress. The report articulates broad aims and
priorities guiding CMS programs, regulations, and initiatives.*
12. **What was one of the objectives of CMS?**
*"CMS, in collaboration with public and private partners, is transforming how we conduct
business and operations, connect providers, and empower consumers and
beneficiaries. We are working to build a healthcare delivery system that is better,
smarter, and healthier—a system that delivers improved care, spends healthcare dollars
more wisely, and makes our communities healthier."*
13. **What is the CMS Quality Strategy?**
*The CMS quality strategy includes aims to provide better, more affordable care, and
priorities to guide efforts to improve health and healthcare quality.*
14. **What are the three aims of the CMS Quality Strategy?**
*1. Better Care: Improve the overall quality of care by making healthcare more person-
centered, reliable, accessible, and safe.*
*2. Healthier People, Healthier Communities: Improve the health of Americans by
supporting proven interventions to address behavioral, social, and environmental
determinants of health, and deliver higher-quality care.*
*3. Smarter Spending: Reduce the cost of quality healthcare for individuals, families,
employers, government, and communities.*
15. **What are the six priorities of the CMS Quality Strategy?**
, *1. Make Care Safer by Reducing Harm Caused in the Delivery of Care*
*2. Strengthen Person and Family Engagement as Partners in Their Care*
*3. Promote Effective Communication and Coordination of Care*
*4. Promote Effective Prevention and Treatment of Chronic Disease*
*5. Work with Communities to Promote Best Practices of Healthy Living*
*6. Make Care Affordable*
16. **What are the four parts to Medicare? What is included in each part?**
*Part A: inpatient hospital care, skilled nursing services, hospice care (acute care)*
*Part B: doctor’s visits, outpatient hospital services, durable medical equipment,
physician-administered drugs*
*Part C: Medicare Advantage plans, which combine parts A & B; may cover vision,
dental, and hearing*
*Part D: prescription drug coverage*
17. **What is included under hospital coverage for Medicare Part A?**
*Inpatient/acute hospital care, surgery, skilled nursing services (SNFs), laboratory tests,
home health visits, hospice services*
18. **What is the yearly deductible for Medicare Part A?**
*$1,484 for 2021. This deductible covers costs for the first 60 days of inpatient hospital
stay. The beneficiary needs a supplemental policy to assist after day 61.*
19. **Describe Acute Care Hospitals (ACHs) under Medicare Part A coverage.**
*Short-term inpatient care requiring a 2-midnight stay to qualify for Part A payment.*
20. **How is an acute care hospital reimbursed?**
