UHC Medicare Certification Exam– Actual Questions &
Answers with Rationales (2026/2027)
1. What are the four main parts of Medicare?
A. Parts A, B, C, and D
B. Parts A, C, D, and F
C. Parts B, C, E, and F
D. Parts A, B, D, and F
Answer: A
Rationale: Medicare Parts A and B are Original Medicare, Part C refers
to Medicare Advantage, and Part D provides prescription drug
coverage.
2. Medicare Part A primarily covers:
A. Physician services
B. Inpatient hospital care
C. Outpatient prescription drugs
D. Routine dental services
Answer: B
Rationale: Part A generally covers inpatient hospital, skilled nursing
facility, hospice, and certain home health services.
3. Medicare Part B primarily covers:
A. Inpatient hospital stays
B. Physician and outpatient services
C. Most retail prescription drugs
D. Long-term custodial care
Answer: B
Rationale: Part B covers medically necessary physician services,
,outpatient care, preventive services, durable medical equipment, and
other covered services.
4. Medicare Advantage is also known as:
A. Medicare Part C
B. Medicare Part D
C. Medigap
D. Medicaid
Answer: A
Rationale: Medicare Advantage plans are Medicare Part C plans offered
by Medicare-approved private organizations.
5. Medicare Part D provides coverage primarily for:
A. Hospitalization
B. Prescription drugs
C. Physician office visits
D. Skilled nursing services
Answer: B
Rationale: Part D is Medicare prescription drug coverage offered
through private Medicare-approved plans.
6. Which organization administers and oversees the Medicare
program?
A. CMS
B. OSHA
C. FDA
D. FTC
Answer: A
Rationale: The Centers for Medicare & Medicaid Services (CMS)
administers Medicare and establishes applicable program
requirements.
,7. Which statement best describes Original Medicare?
A. It is a private Medicare Advantage plan
B. It consists primarily of Parts A and B
C. It automatically includes Part D
D. It requires beneficiaries to use one private network
Answer: B
Rationale: Original Medicare consists of Part A and Part B. Beneficiaries
may separately obtain Part D and supplemental coverage.
8. A Medicare Advantage plan must generally provide coverage for:
A. Only dental services
B. Medicare-covered Part A and Part B services
C. Only prescription drugs
D. Medicaid services only
Answer: B
Rationale: Medicare Advantage plans must cover Medicare-covered
Part A and Part B services, subject to plan rules and applicable
requirements.
9. Which beneficiary generally qualifies for Medicare because of age?
A. Anyone age 55 or older
B. Generally, people age 65 or older who meet eligibility requirements
C. Anyone age 60 or older
D. Anyone receiving Social Security for six months
Answer: B
Rationale: Age 65 is the standard age-based Medicare eligibility
threshold, subject to applicable eligibility requirements.
10. Medicare eligibility can also occur before age 65 because of:
A. Disability or certain qualifying conditions
B. Employment alone
, C. Home ownership
D. Private insurance enrollment
Answer: A
Rationale: Certain people under 65 may qualify for Medicare because
of disability or specific qualifying conditions.
11. What is the purpose of a Medicare Advantage network?
A. To determine Social Security benefits
B. To identify providers contracted with the plan
C. To replace Medicare eligibility rules
D. To determine federal income taxes
Answer: B
Rationale: Provider networks identify doctors, hospitals, and other
providers that have contractual relationships with the plan.
12. In a Health Maintenance Organization (HMO), beneficiaries
generally:
A. Can use any provider without regard to plan rules
B. Receive care through the plan's network, subject to applicable
exceptions
C. Cannot receive preventive care
D. Must purchase a Medigap policy
Answer: B
Rationale: HMOs generally emphasize network care, although
emergency, urgent, and certain other services may be subject to
different rules.
13. A PPO generally provides beneficiaries with:
A. No provider choices
B. In-network and out-of-network coverage, with different cost sharing
Answers with Rationales (2026/2027)
1. What are the four main parts of Medicare?
A. Parts A, B, C, and D
B. Parts A, C, D, and F
C. Parts B, C, E, and F
D. Parts A, B, D, and F
Answer: A
Rationale: Medicare Parts A and B are Original Medicare, Part C refers
to Medicare Advantage, and Part D provides prescription drug
coverage.
2. Medicare Part A primarily covers:
A. Physician services
B. Inpatient hospital care
C. Outpatient prescription drugs
D. Routine dental services
Answer: B
Rationale: Part A generally covers inpatient hospital, skilled nursing
facility, hospice, and certain home health services.
3. Medicare Part B primarily covers:
A. Inpatient hospital stays
B. Physician and outpatient services
C. Most retail prescription drugs
D. Long-term custodial care
Answer: B
Rationale: Part B covers medically necessary physician services,
,outpatient care, preventive services, durable medical equipment, and
other covered services.
4. Medicare Advantage is also known as:
A. Medicare Part C
B. Medicare Part D
C. Medigap
D. Medicaid
Answer: A
Rationale: Medicare Advantage plans are Medicare Part C plans offered
by Medicare-approved private organizations.
5. Medicare Part D provides coverage primarily for:
A. Hospitalization
B. Prescription drugs
C. Physician office visits
D. Skilled nursing services
Answer: B
Rationale: Part D is Medicare prescription drug coverage offered
through private Medicare-approved plans.
6. Which organization administers and oversees the Medicare
program?
A. CMS
B. OSHA
C. FDA
D. FTC
Answer: A
Rationale: The Centers for Medicare & Medicaid Services (CMS)
administers Medicare and establishes applicable program
requirements.
,7. Which statement best describes Original Medicare?
A. It is a private Medicare Advantage plan
B. It consists primarily of Parts A and B
C. It automatically includes Part D
D. It requires beneficiaries to use one private network
Answer: B
Rationale: Original Medicare consists of Part A and Part B. Beneficiaries
may separately obtain Part D and supplemental coverage.
8. A Medicare Advantage plan must generally provide coverage for:
A. Only dental services
B. Medicare-covered Part A and Part B services
C. Only prescription drugs
D. Medicaid services only
Answer: B
Rationale: Medicare Advantage plans must cover Medicare-covered
Part A and Part B services, subject to plan rules and applicable
requirements.
9. Which beneficiary generally qualifies for Medicare because of age?
A. Anyone age 55 or older
B. Generally, people age 65 or older who meet eligibility requirements
C. Anyone age 60 or older
D. Anyone receiving Social Security for six months
Answer: B
Rationale: Age 65 is the standard age-based Medicare eligibility
threshold, subject to applicable eligibility requirements.
10. Medicare eligibility can also occur before age 65 because of:
A. Disability or certain qualifying conditions
B. Employment alone
, C. Home ownership
D. Private insurance enrollment
Answer: A
Rationale: Certain people under 65 may qualify for Medicare because
of disability or specific qualifying conditions.
11. What is the purpose of a Medicare Advantage network?
A. To determine Social Security benefits
B. To identify providers contracted with the plan
C. To replace Medicare eligibility rules
D. To determine federal income taxes
Answer: B
Rationale: Provider networks identify doctors, hospitals, and other
providers that have contractual relationships with the plan.
12. In a Health Maintenance Organization (HMO), beneficiaries
generally:
A. Can use any provider without regard to plan rules
B. Receive care through the plan's network, subject to applicable
exceptions
C. Cannot receive preventive care
D. Must purchase a Medigap policy
Answer: B
Rationale: HMOs generally emphasize network care, although
emergency, urgent, and certain other services may be subject to
different rules.
13. A PPO generally provides beneficiaries with:
A. No provider choices
B. In-network and out-of-network coverage, with different cost sharing
