1|Page
UHC MEDICARE BASICS
TEST|COMPREHENSIVE Q&A FOR
CERTIFICATION SUCCESS 2026
UPDATE
member Doug enrolled in a health maintenance organization HMO MA plan he
saw an out of network doctor and received a bill for the entire cost of the visit
Doug called Medicare to complain and stated that he was never told about these
types of costs what should the agent and explain better to Doug when he was
enrolled in the plan select three - correct-answer -that dog must receive coverage
services from contract in network providers
that in most cases Doug will pay the entire cost of the service if he sees an out of
network provider
that exceptions to the provider network requirement are emergency visits urgent
care and rental dialysis services which can be obtained from out of network
providers
,2|Page
a consumer with original Medicare might be interested in an MA plan because -
correct-answer -MA plans typically provide additional coverage beyond original
Medicare and often have established copayments for some benefits
a government program offered only through a private insurance company or
other private company approved by Medicare that provides prescription drug
coverage describes which of the following - correct-answer -Medicare Part D
aside from a Medicare Advantage plan or other health plan that includes
prescription drug coverage how else could a medicare eligible consumer get Part
D prescription drug coverage - correct-answer -they can enroll on a standalone
Medicare prescription drug plan PDP
In what order do the four prescription drug coverage stages occur - correct-
answer -deductible initial coverage coverage gap catastrophic coverage
, 3|Page
which of the following options or drug utilization management UM rules select
three - correct-answer -quantity limit
prior authorization
step therapy
formulary is defined as - correct-answer -Alyssa medications covered within the
benefit plan based on CMS guidelines and develop in collaboration with
physicians and pharmacists
the new MACRA legislation which went into effect January 1st 2020 applies to all
carriers offering Medicare supplement plans - correct-answer -true
UHC MEDICARE BASICS
TEST|COMPREHENSIVE Q&A FOR
CERTIFICATION SUCCESS 2026
UPDATE
member Doug enrolled in a health maintenance organization HMO MA plan he
saw an out of network doctor and received a bill for the entire cost of the visit
Doug called Medicare to complain and stated that he was never told about these
types of costs what should the agent and explain better to Doug when he was
enrolled in the plan select three - correct-answer -that dog must receive coverage
services from contract in network providers
that in most cases Doug will pay the entire cost of the service if he sees an out of
network provider
that exceptions to the provider network requirement are emergency visits urgent
care and rental dialysis services which can be obtained from out of network
providers
,2|Page
a consumer with original Medicare might be interested in an MA plan because -
correct-answer -MA plans typically provide additional coverage beyond original
Medicare and often have established copayments for some benefits
a government program offered only through a private insurance company or
other private company approved by Medicare that provides prescription drug
coverage describes which of the following - correct-answer -Medicare Part D
aside from a Medicare Advantage plan or other health plan that includes
prescription drug coverage how else could a medicare eligible consumer get Part
D prescription drug coverage - correct-answer -they can enroll on a standalone
Medicare prescription drug plan PDP
In what order do the four prescription drug coverage stages occur - correct-
answer -deductible initial coverage coverage gap catastrophic coverage
, 3|Page
which of the following options or drug utilization management UM rules select
three - correct-answer -quantity limit
prior authorization
step therapy
formulary is defined as - correct-answer -Alyssa medications covered within the
benefit plan based on CMS guidelines and develop in collaboration with
physicians and pharmacists
the new MACRA legislation which went into effect January 1st 2020 applies to all
carriers offering Medicare supplement plans - correct-answer -true
