UHC Cer fica on ques on and answers latest
2026 update
Joseph has Original Medicare and was a pa ent in the hospital last week. What part of
Medicare helps cover the costs of his inpa ent hospital stay?
Part A
The consumer must be in a valid MA elec on or disenrollment period.
Which of the following consumers would be eligible for Medicare?
Consumers age 65 or older, consumers under 65 years of age with certain disabili es for
more than 24 months and consumers of all ages with ESRD or ALS
Which of the following defines a Medicare Advantage (MA) Plan?
MA Plans are health plan op ons approved by Medicare and offered by private insurance
companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements
must she meet? (Select the two answers that apply.)
Not have End Stage Renal Disease (permanent kidney failure)Reside in the plan's service
area
What must be explained to consumers enrolling in an HMO (Health Maintenance
Organiza on) MA Plan? (Select 3)
Which of the following are MA Plans that focus on using network providers to maximize the
benefits and reduce out-of-network expenses?
HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment?
By federal law, Medicare Supplement Open Enrollment is the first 6 months a consumer is 65
or older and enrolled in Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work?
The OOP maximum is a feature that limits the amount of money a consumer will have to
spend on Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescrip on
Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescrip on drug coverage?
, The consumer will be automa cally disenrolled from their stand-alone PDP upon enrollment
in the MA Plan that has integrated prescrip on drug coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescrip on drug coverage describes which
of the following:
Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare
Prescrip on Drug Plans?
A consumer must be en tled to Medicare Part A and/or enrolled in Medicare Part B
What are two op ons for Medicare consumers to get Part D prescrip on drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
Which of the following statements is not true about the Coverage Gap?
All members reach the Coverage Gap
Which of the following op ons are drug u liza on management (UM) rules? (Select 3)
Which of the following best describes the Late Enrollment Penalty (LEP)?
The amount added to the member's monthly plan premium if they did not enroll in a
Medicare Advantage plan with Part D benefits or stand-alone prescrip on drug plan when
they were first eligible for Medicare Parts A and/or B or went without creditable prescrip on
drug coverage for 63 con nuous days or more.
Through which means is financial assistance offered to a consumer who qualifies for Low
Income Subsidy for their part of Medicare Part D costs?
Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Medica ons that are covered in a Plan's formulary have various levels of associated member
cost-sharing (copayments or coinsurance). What are these drug levels called?
Drug ers
In states where Medicare Supplement Insurance underwri ng criteria can apply, all of the
following underwri ng criteria apply EXCEPT:
Consumers may be underwriBen to determine their acceptance and, if applicable, their rate.
The new MACRA legisla on, which went into effect January 1, 2020, applies to all carriers
offering Medicare supplement plans.
TRUE
Which of the following is NOT true of Medicare Supplement Insurance Plans?
2026 update
Joseph has Original Medicare and was a pa ent in the hospital last week. What part of
Medicare helps cover the costs of his inpa ent hospital stay?
Part A
The consumer must be in a valid MA elec on or disenrollment period.
Which of the following consumers would be eligible for Medicare?
Consumers age 65 or older, consumers under 65 years of age with certain disabili es for
more than 24 months and consumers of all ages with ESRD or ALS
Which of the following defines a Medicare Advantage (MA) Plan?
MA Plans are health plan op ons approved by Medicare and offered by private insurance
companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements
must she meet? (Select the two answers that apply.)
Not have End Stage Renal Disease (permanent kidney failure)Reside in the plan's service
area
What must be explained to consumers enrolling in an HMO (Health Maintenance
Organiza on) MA Plan? (Select 3)
Which of the following are MA Plans that focus on using network providers to maximize the
benefits and reduce out-of-network expenses?
HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment?
By federal law, Medicare Supplement Open Enrollment is the first 6 months a consumer is 65
or older and enrolled in Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work?
The OOP maximum is a feature that limits the amount of money a consumer will have to
spend on Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescrip on
Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescrip on drug coverage?
, The consumer will be automa cally disenrolled from their stand-alone PDP upon enrollment
in the MA Plan that has integrated prescrip on drug coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescrip on drug coverage describes which
of the following:
Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare
Prescrip on Drug Plans?
A consumer must be en tled to Medicare Part A and/or enrolled in Medicare Part B
What are two op ons for Medicare consumers to get Part D prescrip on drug coverage
(assuming they meet all eligibility requirements)? (Select 2)
Which of the following statements is not true about the Coverage Gap?
All members reach the Coverage Gap
Which of the following op ons are drug u liza on management (UM) rules? (Select 3)
Which of the following best describes the Late Enrollment Penalty (LEP)?
The amount added to the member's monthly plan premium if they did not enroll in a
Medicare Advantage plan with Part D benefits or stand-alone prescrip on drug plan when
they were first eligible for Medicare Parts A and/or B or went without creditable prescrip on
drug coverage for 63 con nuous days or more.
Through which means is financial assistance offered to a consumer who qualifies for Low
Income Subsidy for their part of Medicare Part D costs?
Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Medica ons that are covered in a Plan's formulary have various levels of associated member
cost-sharing (copayments or coinsurance). What are these drug levels called?
Drug ers
In states where Medicare Supplement Insurance underwri ng criteria can apply, all of the
following underwri ng criteria apply EXCEPT:
Consumers may be underwriBen to determine their acceptance and, if applicable, their rate.
The new MACRA legisla on, which went into effect January 1, 2020, applies to all carriers
offering Medicare supplement plans.
TRUE
Which of the following is NOT true of Medicare Supplement Insurance Plans?
