UHC MEDICARE BASICS STUDY GUIDE UPDATED
QUESTIONS AND ANSWERS RATED A+
✔✔A consumer with only Part A residing in the plan's service area can enroll in which
plan type to get Part D coverage? - ✔✔A stand-alone Part D Plan.
✔✔Which of the following statements accurately describes a prescription drug stage? -
✔✔Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
✔✔Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and
Limited Access are all examples of what? - ✔✔Utilization Management Rules
✔✔A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll
in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan
when they were first eligible for Medicare Parts A and/or B or went without creditable
prescription drug coverage for ______________. - ✔✔63 or more continuous days
✔✔How does a consumer who qualifies for Low Income Subsidy receive financial
assistance for their part of Medicare Part D costs? - ✔✔Through subsidies such as
lower or no monthly plan premiums and lower or no copayments.
✔✔Which of the following is a characteristic of a drug tier? - ✔✔All of the drugs in the
tier have the same copayment or coinsurance.
✔✔Which of the following is true about Medicare Supplement Insurance underwriting
criteria in states where underwriting applies? - ✔✔Underwriting is required if the
consumer is not in their Medicare Supplement Open Enrollment period or does not meet
Guaranteed Issue criteria.
✔✔Which of the following are true about the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select
, 2) - ✔✔-Consumers eligible for Medicare Part A before January 1, 2020, can enroll in
Plan C or F even after 2020 and can keep their plans as long as they choose.
-Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to
purchase Medicare Supplement Insurance Plans C or F.
✔✔Which statement is true of Medicare Supplement Insurance Plans? - ✔✔Insured
members have the freedom to choose any doctor who accepts Medicare patients.
✔✔Select the option that accurately represents Medicare Advantage (MA) Plan network
characteristics (non-emergency care). - ✔✔Members in a PPO plan can use out-of-
network benefits but generally at a higher cost.
✔✔Which statement is true about the Medicare Advantage (MA) Out-of-Pocket
Maximum? - ✔✔All MA plans have an Out-of-Pocket Maximum to help limit the
member's out-of-pocket costs for Medicare-covered medical services.
✔✔Which is true about Medicare Supplement Open Enrollment? - ✔✔It is the six-month
that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.
✔✔When is a Medicare Supplement Insurance consumer subject to underwriting and
screened for eligibility? - ✔✔When the consumer is not in their Medicare Supplement
Open Enrollment or does not meet Guaranteed Issue criteria.
✔✔Which of the following statements is true about using a 5-Star Special Enrollment
Period (SEP)? - ✔✔It can be used once from December 8 through November 30 to
enroll in a 5-Star plan and coverage will start the first of the month following receipt of
the enrollment application.
✔✔Milton is retiring on his 65th birthday. He is eligible for Medicare and already
receives Social Security benefits. How does he enroll in Original Medicare? - ✔✔His
enrollment in Medicare Parts A and B is generally automatic if he meets all eligibility
requirements
✔✔Which statement is true about a member of a Medicare Advantage (MA) Plan who
wants to enroll in a Medicare Supplement Insurance Plan? - ✔✔When a consumer
enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled
from their MA plan.
✔✔Which of the following are eligibility requirements for enrollment in a Medicare
Advantage Plan? (Select 3) - ✔✔-Is entitled to Medicare Part A
-Is enrolled in Medicare Part B
-Resides in the plan's service area
QUESTIONS AND ANSWERS RATED A+
✔✔A consumer with only Part A residing in the plan's service area can enroll in which
plan type to get Part D coverage? - ✔✔A stand-alone Part D Plan.
✔✔Which of the following statements accurately describes a prescription drug stage? -
✔✔Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
✔✔Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and
Limited Access are all examples of what? - ✔✔Utilization Management Rules
✔✔A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll
in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan
when they were first eligible for Medicare Parts A and/or B or went without creditable
prescription drug coverage for ______________. - ✔✔63 or more continuous days
✔✔How does a consumer who qualifies for Low Income Subsidy receive financial
assistance for their part of Medicare Part D costs? - ✔✔Through subsidies such as
lower or no monthly plan premiums and lower or no copayments.
✔✔Which of the following is a characteristic of a drug tier? - ✔✔All of the drugs in the
tier have the same copayment or coinsurance.
✔✔Which of the following is true about Medicare Supplement Insurance underwriting
criteria in states where underwriting applies? - ✔✔Underwriting is required if the
consumer is not in their Medicare Supplement Open Enrollment period or does not meet
Guaranteed Issue criteria.
✔✔Which of the following are true about the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select
, 2) - ✔✔-Consumers eligible for Medicare Part A before January 1, 2020, can enroll in
Plan C or F even after 2020 and can keep their plans as long as they choose.
-Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to
purchase Medicare Supplement Insurance Plans C or F.
✔✔Which statement is true of Medicare Supplement Insurance Plans? - ✔✔Insured
members have the freedom to choose any doctor who accepts Medicare patients.
✔✔Select the option that accurately represents Medicare Advantage (MA) Plan network
characteristics (non-emergency care). - ✔✔Members in a PPO plan can use out-of-
network benefits but generally at a higher cost.
✔✔Which statement is true about the Medicare Advantage (MA) Out-of-Pocket
Maximum? - ✔✔All MA plans have an Out-of-Pocket Maximum to help limit the
member's out-of-pocket costs for Medicare-covered medical services.
✔✔Which is true about Medicare Supplement Open Enrollment? - ✔✔It is the six-month
that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.
✔✔When is a Medicare Supplement Insurance consumer subject to underwriting and
screened for eligibility? - ✔✔When the consumer is not in their Medicare Supplement
Open Enrollment or does not meet Guaranteed Issue criteria.
✔✔Which of the following statements is true about using a 5-Star Special Enrollment
Period (SEP)? - ✔✔It can be used once from December 8 through November 30 to
enroll in a 5-Star plan and coverage will start the first of the month following receipt of
the enrollment application.
✔✔Milton is retiring on his 65th birthday. He is eligible for Medicare and already
receives Social Security benefits. How does he enroll in Original Medicare? - ✔✔His
enrollment in Medicare Parts A and B is generally automatic if he meets all eligibility
requirements
✔✔Which statement is true about a member of a Medicare Advantage (MA) Plan who
wants to enroll in a Medicare Supplement Insurance Plan? - ✔✔When a consumer
enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled
from their MA plan.
✔✔Which of the following are eligibility requirements for enrollment in a Medicare
Advantage Plan? (Select 3) - ✔✔-Is entitled to Medicare Part A
-Is enrolled in Medicare Part B
-Resides in the plan's service area
