UHC Certification Exam Study Guide Questions
And Answers Verified 100% Correct
Mr. Carlini has heard that Medicare prescription drug plans are only
offered through private companies under a program known as Medicare
Advantage (MA), not by the government. He likes Original Medicare
and does not want to sign up for an MA product, but he also wants
prescription drug coverage. What should you tell him? - ANSWER- b.
Mr. Carlini can stay with Original Medicare and also enroll in a
Medicare prescription drug plan through a private company that has
contracted with the government to provide only such drug coverage to
eligible Medicare beneficiaries.
Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is
wondering if there is any other option he has for obtaining help with his
considerable drug costs. What should you tell him? - ANSWER- b. He
could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means to obtain
the medications they need. Alternatively, he could check to see whether
his state has a pharmacy assistance program to help him with his
expenses.
Mr. Shultz was still working when he first qualified for Medicare. At
that time, he had employer group coverage that was creditable. During
his initial Part D eligibility period, he decided not to enroll because he
was satisfied with his drug coverage. It is now a year later and Mr.
Shultz has lost his employer group coverage within the last two weeks.
How would you advise him? - ANSWER- d. Mr. Schultz should enroll
in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
,All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the
costs a beneficiary would incur for prescription drugs under the standard
coverage? - ANSWER- c. Standard Part D coverage would require
payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either
the co-pays for generic and brand name drugs or coinsurance of 5%.
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan's formulary he takes several
other medications. These include a prescription drug not on his plan's
formulary, over-the-counter medications for colds and allergies,
vitamins, and drugs from an Internet-based Canadian pharmacy to
promote hair growth and reduce joint swelling. His neighbor recently
told him about a concept called TrOOP and he asks you if any of his
other medications could count toward TrOOP should he ever reach the
Part D catastrophic limit. What should you say? - ANSWER- c. None of
the costs of Mr. Wingate's other medications would currently count
toward TrOOP but he may wish to ask his plan for an exception to cover
the prescription not on its formulary.
Mr. Jacob understands that there is a standard Medicare Part D
prescription drug benefit, but when he looks at information on various
plans available in his area, he sees a wide range in what they charge for
deductibles, premiums, and cost sharing. How can you explain this to
him? - ANSWER- a. Medicare Part D drug plans may have different
benefit structures, but on average, they must all be at least as good as the
standard model established by the government.
Mrs. Roswell is a new Medicare beneficiary who has just retired from
retail work. She is interested in selecting a Medicare Part D prescription
drug plan. She takes a number of medications and is concerned that she
has not been able to identify a plan that covers all of her medications.
,She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her? -
ANSWER- b. Every Part D drug plan is required to cover a single
onemonth fill of her existing medications sometime during a 90-day
transition period.
Mr. Zachow has a condition for which three drugs are available. He has
tried two but had an allergic reaction to them. Only the third drug works
for him and it is not on his Part D plan's formulary. What could you tell
him to do? - ANSWER- c. Mr. Zachow has a right to request a
formulary exception to obtain coverage for his Part D drug. He or his
physician could obtain the standardized request form on the plan's
website, fill it out, and submit it to his plan.
Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from
his savings account until it is exhausted, and then have his premiums
withheld from his Social Security check. What should you tell him? -
ANSWER- c. In general, he must select a single Part D premium
payment mechanism that will be used throughout the year.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription
each day. Mr. Vaughn takes a prescription for helping to regrow his hair.
They are anxious to have their Medicare prescription drug plan cover
these drug needs. What should you tell them? - ANSWER- d. Medicare
prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the
Vaughn's could look into that possibility.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies
regardless of health status except in limited circumstances. II. Private
, fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA)
plan may only obtain Part D benefits through a standalone PDP. IV.
Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through
a standalone PDP or through their plan. - ANSWER- c. I, II, and III only
Mr. Shapiro gets by on a very small amount of fixed income. He has
heard there may be extra help paying for Part D prescription drugs for
Medicare beneficiaries with limited income. He wants to know whether
he might qualify. What should you tell him? - ANSWER- b. The extra
help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it.
What do you say? - ANSWER- a. TrOOP stands for true out-of-pocket
expenses that count toward the Medicare Part D catastrophic limit and
include only expenses paid directly by a Medicare Part D beneficiary.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes
prescription drug plan (PDP) coverage. She is traveling and wishes to
fill two of the prescriptions that she has lost. How would you advise her?
- ANSWER- c. She may fill prescriptions for covered drugs at
nonnetwork pharmacies, but likely at a higher cost than paid at an
innetwork pharmacy.
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? - ANSWER- c.
Part D plans do not have to cover all medications. As a result, their
formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-
payments and prior authorization.
And Answers Verified 100% Correct
Mr. Carlini has heard that Medicare prescription drug plans are only
offered through private companies under a program known as Medicare
Advantage (MA), not by the government. He likes Original Medicare
and does not want to sign up for an MA product, but he also wants
prescription drug coverage. What should you tell him? - ANSWER- b.
Mr. Carlini can stay with Original Medicare and also enroll in a
Medicare prescription drug plan through a private company that has
contracted with the government to provide only such drug coverage to
eligible Medicare beneficiaries.
Mr. Bickford did not quite qualify for the extra help low-income subsidy
under the Medicare Part D Prescription Drug program and he is
wondering if there is any other option he has for obtaining help with his
considerable drug costs. What should you tell him? - ANSWER- b. He
could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means to obtain
the medications they need. Alternatively, he could check to see whether
his state has a pharmacy assistance program to help him with his
expenses.
Mr. Shultz was still working when he first qualified for Medicare. At
that time, he had employer group coverage that was creditable. During
his initial Part D eligibility period, he decided not to enroll because he
was satisfied with his drug coverage. It is now a year later and Mr.
Shultz has lost his employer group coverage within the last two weeks.
How would you advise him? - ANSWER- d. Mr. Schultz should enroll
in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
,All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the
costs a beneficiary would incur for prescription drugs under the standard
coverage? - ANSWER- c. Standard Part D coverage would require
payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either
the co-pays for generic and brand name drugs or coinsurance of 5%.
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of
your clients. In addition to drugs on his plan's formulary he takes several
other medications. These include a prescription drug not on his plan's
formulary, over-the-counter medications for colds and allergies,
vitamins, and drugs from an Internet-based Canadian pharmacy to
promote hair growth and reduce joint swelling. His neighbor recently
told him about a concept called TrOOP and he asks you if any of his
other medications could count toward TrOOP should he ever reach the
Part D catastrophic limit. What should you say? - ANSWER- c. None of
the costs of Mr. Wingate's other medications would currently count
toward TrOOP but he may wish to ask his plan for an exception to cover
the prescription not on its formulary.
Mr. Jacob understands that there is a standard Medicare Part D
prescription drug benefit, but when he looks at information on various
plans available in his area, he sees a wide range in what they charge for
deductibles, premiums, and cost sharing. How can you explain this to
him? - ANSWER- a. Medicare Part D drug plans may have different
benefit structures, but on average, they must all be at least as good as the
standard model established by the government.
Mrs. Roswell is a new Medicare beneficiary who has just retired from
retail work. She is interested in selecting a Medicare Part D prescription
drug plan. She takes a number of medications and is concerned that she
has not been able to identify a plan that covers all of her medications.
,She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her? -
ANSWER- b. Every Part D drug plan is required to cover a single
onemonth fill of her existing medications sometime during a 90-day
transition period.
Mr. Zachow has a condition for which three drugs are available. He has
tried two but had an allergic reaction to them. Only the third drug works
for him and it is not on his Part D plan's formulary. What could you tell
him to do? - ANSWER- c. Mr. Zachow has a right to request a
formulary exception to obtain coverage for his Part D drug. He or his
physician could obtain the standardized request form on the plan's
website, fill it out, and submit it to his plan.
Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal from
his savings account until it is exhausted, and then have his premiums
withheld from his Social Security check. What should you tell him? -
ANSWER- c. In general, he must select a single Part D premium
payment mechanism that will be used throughout the year.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription
each day. Mr. Vaughn takes a prescription for helping to regrow his hair.
They are anxious to have their Medicare prescription drug plan cover
these drug needs. What should you tell them? - ANSWER- d. Medicare
prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the
Vaughn's could look into that possibility.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies
regardless of health status except in limited circumstances. II. Private
, fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA)
plan may only obtain Part D benefits through a standalone PDP. IV.
Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through
a standalone PDP or through their plan. - ANSWER- c. I, II, and III only
Mr. Shapiro gets by on a very small amount of fixed income. He has
heard there may be extra help paying for Part D prescription drugs for
Medicare beneficiaries with limited income. He wants to know whether
he might qualify. What should you tell him? - ANSWER- b. The extra
help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it.
What do you say? - ANSWER- a. TrOOP stands for true out-of-pocket
expenses that count toward the Medicare Part D catastrophic limit and
include only expenses paid directly by a Medicare Part D beneficiary.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes
prescription drug plan (PDP) coverage. She is traveling and wishes to
fill two of the prescriptions that she has lost. How would you advise her?
- ANSWER- c. She may fill prescriptions for covered drugs at
nonnetwork pharmacies, but likely at a higher cost than paid at an
innetwork pharmacy.
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? - ANSWER- c.
Part D plans do not have to cover all medications. As a result, their
formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-
payments and prior authorization.
