UHC Medicare – Medicare Advantage Plans, PFFS, HMO, and PPO Exam Actual Questions & Answers with Rationales (2026/2027)

UHC Medicare – Medicare Advantage Plans, PFFS, HMO, and
PPO Exam Actual Questions & Answers with Rationales
(2026/2027)
1. Medicare Advantage is also known as:
A. Part A
B. Part B
C. Part C
D. Part D
Answer: C
Rationale: Medicare Advantage (MA) is Medicare Part C.
2. Which organization administers Medicare Advantage under a
contract with Medicare?
A. A Medicare Advantage organization
B. A state Medicaid agency only
C. A hospital
D. A Medigap carrier
Answer: A
Rationale: MA plans are offered by Medicare-approved private
organizations that contract with Medicare.
3. Which two Medicare components are generally required for
enrollment in an MA plan?
A. Part A and Part B
B. Part B and Part D
C. Part A and Medigap
D. Part D and Medicaid
Answer: A
Rationale: An individual generally must have both Medicare Part A and
Part B to enroll in MA.

,4. What is an HMO?
A. Health Maintenance Organization
B. Hospital Medicare Option
C. Health Medicare Office
D. Hospital Management Organization
Answer: A
Rationale: HMO stands for Health Maintenance Organization.
5. What is a PPO?
A. Preferred Provider Organization
B. Primary Payment Organization
C. Preferred Pharmacy Option
D. Provider Payment Office
Answer: A
Rationale: PPO stands for Preferred Provider Organization.
6. What does PFFS stand for?
A. Private Fee-for-Service
B. Preferred Fee-for-Service
C. Private Family Financial Service
D. Primary Fee-for-Service
Answer: A
Rationale: PFFS means Private Fee-for-Service.
7. Which MA plan type generally uses a defined network and often
requires members to select a primary care provider?
A. HMO
B. PPO
C. PFFS
D. Medigap

,Answer: A
Rationale: HMOs generally emphasize coordinated care through a
network and may require a PCP selection.
8. Which plan type generally provides both in-network and out-of-
network coverage, with different cost sharing?
A. PPO
B. HMO
C. PFFS only
D. Original Medicare only
Answer: A
Rationale: PPOs generally allow members to obtain covered services
from out-of-network providers, usually at higher cost.
9. What is a defining feature of a PFFS plan?
A. The plan determines how much it will pay for covered services and
how much the member pays
B. Members must always use a PCP
C. Every provider is automatically required to participate
D. Referrals are always required
Answer: A
Rationale: PFFS plans establish payment terms for covered services and
provider/member cost sharing.
10. In an HMO, what is a major reason for using network providers?
A. To receive services according to the plan's network rules and
generally lower cost sharing
B. To avoid Medicare eligibility
C. To obtain Medigap coverage
D. To eliminate all cost sharing

, Answer: A
Rationale: HMO benefits are generally structured around the plan's
provider network.
11. Which plan generally offers the greatest flexibility to see out-of-
network providers among the three listed?
A. PPO
B. HMO
C. PFFS
D. None
Answer: A
Rationale: PPOs generally provide broader provider flexibility, subject
to plan rules and higher out-of-network costs.
12. Does a PPO necessarily require a referral to see every specialist?
A. No
B. Yes, always
C. Only for emergency care
D. Only for inpatient care
Answer: A
Rationale: PPOs generally do not require specialist referrals, although
plan-specific rules should always be checked.
13. Does an HMO always cover routine out-of-network care?
A. No
B. Yes
C. Only if the provider is expensive
D. Only during AEP
Answer: A
Rationale: HMO plans generally restrict routine covered care to their
network, except for specified circumstances.