UHC MEDICARE CERTIFICATION EXAM (2026/2027) QUESTIONS
AND ANSWERS WITH RATIONALES EACH | CURRENTLY TESTING
AND FREQUENTLY TESTED QUESTIONS |
LATEST UPDATE
SECTION 1: MEDICARE BASICS & ELIGIBILITY (Questions 1-50)
QUESTION 1
Which of the following individuals is eligible for Medicare?
A) Only individuals age 65 and older
B) Individuals age 65 and older, and those under 65 with certain disabilities
C) Only individuals receiving Social Security benefits
D) All U.S. citizens regardless of age
>>> B) Individuals age 65 and older, and those under 65 with certain
disabilities
RATIONALE:
Medicare eligibility extends beyond just age 65. Individuals under 65 who
have received Social Security Disability Insurance (SSDI) for 24 months are
also eligible. Additionally, those with End-Stage Renal Disease (ESRD) or
Amyotrophic Lateral Sclerosis (ALS) qualify regardless of age. Not all U.S.
citizens are eligible, and eligibility is not dependent on receiving Social
Security benefits alone.
QUESTION 2
Medicare is administered by which federal agency?
A) Department of Health and Human Services (HHS)
B) Social Security Administration (SSA)
C) Centers for Medicare & Medicaid Services (CMS)
D) Food and Drug Administration (FDA)
>>> C) Centers for Medicare & Medicaid Services (CMS)
1
,RATIONALE:
CMS is the federal agency responsible for administering the Medicare
program. While the Social Security Administration handles initial enrollment
and premium collections, CMS oversees all aspects of Medicare policy,
coverage, payment, and quality standards. HHS is the parent department,
and FDA deals with drugs and medical devices.
QUESTION 3
What does Medicare Part A cover?
A) Doctor visits and outpatient care
B) Prescription drugs
C) Inpatient hospital stays, hospice care, and skilled nursing facility care
D) Dental and vision services
>>> C) Inpatient hospital stays, hospice care, and skilled nursing facility care
RATIONALE:
Medicare Part A is often called "hospital insurance." It covers inpatient
hospital stays, skilled nursing facility care (not custodial care), hospice, and
some home health services. It does not cover doctor visits (Part B), drugs
(Part D), or dental and vision (generally not covered under Original
Medicare).
QUESTION 4
What does Medicare Part B cover?
A) Inpatient hospital stays
B) Prescription drugs
C) Doctor visits, outpatient care, and preventive services
D) Long-term care
>>> C) Doctor visits, outpatient care, and preventive services
RATIONALE:
2
,Medicare Part B is "medical insurance" covering outpatient services
including doctor visits, lab tests, preventive care, durable medical
equipment, and some home health services. It requires a monthly premium
and is optional. Part B does not cover inpatient stays, which are covered by
Part A, or long-term custodial care.
QUESTION 5
What is Medicare Part C?
A) Prescription drug coverage
B) Medicare Advantage plans offered by private insurance companies
C) Supplemental insurance (Medigap)
D) Long-term care insurance
>>> B) Medicare Advantage plans offered by private insurance companies
RATIONALE:
Medicare Part C, also known as Medicare Advantage, allows private
insurance companies to provide Medicare benefits. These plans must cover
everything that Original Medicare covers but often include additional
benefits like vision, dental, and hearing. Medigap is supplemental insurance,
and Part D covers prescription drugs.
QUESTION 6
What does Medicare Part D cover?
A) Hospital stays
B) Doctor visits
C) Prescription drugs
D) Dental and vision
>>> C) Prescription drugs
RATIONALE:
Medicare Part D is the prescription drug benefit. It is offered through private
3
, insurance companies that contract with CMS. Part D plans help cover the
cost of prescription medications and are available as standalone plans or as
part of Medicare Advantage plans that include drug coverage.
QUESTION 7
What is the Initial Enrollment Period (IEP) for Medicare?
A) A 6-month period before and after turning 65
B) A 7-month period that includes the 3 months before, the month of, and 3
months after turning 65
C) A 6-month period after turning 65
D) A 12-month period before and after turning 65
>>> B) A 7-month period that includes the 3 months before, the month of,
and 3 months after turning 65
RATIONALE:
The Initial Enrollment Period is 7 months total: the 3 months before the
month of a person's 65th birthday, the month they turn 65, and the 3
months after. Enrolling during this window ensures coverage begins on time
without penalties. Enrolling in the first 3 months starts coverage on the 1st
of the birthday month.
QUESTION 8
What is the General Enrollment Period (GEP) for Medicare Part B?
A) January 1 to March 31 each year
B) April 1 to June 30 each year
C) October 15 to December 7 each year
D) January 1 to February 14 each year
>>> A) January 1 to March 31 each year
RATIONALE:
4
AND ANSWERS WITH RATIONALES EACH | CURRENTLY TESTING
AND FREQUENTLY TESTED QUESTIONS |
LATEST UPDATE
SECTION 1: MEDICARE BASICS & ELIGIBILITY (Questions 1-50)
QUESTION 1
Which of the following individuals is eligible for Medicare?
A) Only individuals age 65 and older
B) Individuals age 65 and older, and those under 65 with certain disabilities
C) Only individuals receiving Social Security benefits
D) All U.S. citizens regardless of age
>>> B) Individuals age 65 and older, and those under 65 with certain
disabilities
RATIONALE:
Medicare eligibility extends beyond just age 65. Individuals under 65 who
have received Social Security Disability Insurance (SSDI) for 24 months are
also eligible. Additionally, those with End-Stage Renal Disease (ESRD) or
Amyotrophic Lateral Sclerosis (ALS) qualify regardless of age. Not all U.S.
citizens are eligible, and eligibility is not dependent on receiving Social
Security benefits alone.
QUESTION 2
Medicare is administered by which federal agency?
A) Department of Health and Human Services (HHS)
B) Social Security Administration (SSA)
C) Centers for Medicare & Medicaid Services (CMS)
D) Food and Drug Administration (FDA)
>>> C) Centers for Medicare & Medicaid Services (CMS)
1
,RATIONALE:
CMS is the federal agency responsible for administering the Medicare
program. While the Social Security Administration handles initial enrollment
and premium collections, CMS oversees all aspects of Medicare policy,
coverage, payment, and quality standards. HHS is the parent department,
and FDA deals with drugs and medical devices.
QUESTION 3
What does Medicare Part A cover?
A) Doctor visits and outpatient care
B) Prescription drugs
C) Inpatient hospital stays, hospice care, and skilled nursing facility care
D) Dental and vision services
>>> C) Inpatient hospital stays, hospice care, and skilled nursing facility care
RATIONALE:
Medicare Part A is often called "hospital insurance." It covers inpatient
hospital stays, skilled nursing facility care (not custodial care), hospice, and
some home health services. It does not cover doctor visits (Part B), drugs
(Part D), or dental and vision (generally not covered under Original
Medicare).
QUESTION 4
What does Medicare Part B cover?
A) Inpatient hospital stays
B) Prescription drugs
C) Doctor visits, outpatient care, and preventive services
D) Long-term care
>>> C) Doctor visits, outpatient care, and preventive services
RATIONALE:
2
,Medicare Part B is "medical insurance" covering outpatient services
including doctor visits, lab tests, preventive care, durable medical
equipment, and some home health services. It requires a monthly premium
and is optional. Part B does not cover inpatient stays, which are covered by
Part A, or long-term custodial care.
QUESTION 5
What is Medicare Part C?
A) Prescription drug coverage
B) Medicare Advantage plans offered by private insurance companies
C) Supplemental insurance (Medigap)
D) Long-term care insurance
>>> B) Medicare Advantage plans offered by private insurance companies
RATIONALE:
Medicare Part C, also known as Medicare Advantage, allows private
insurance companies to provide Medicare benefits. These plans must cover
everything that Original Medicare covers but often include additional
benefits like vision, dental, and hearing. Medigap is supplemental insurance,
and Part D covers prescription drugs.
QUESTION 6
What does Medicare Part D cover?
A) Hospital stays
B) Doctor visits
C) Prescription drugs
D) Dental and vision
>>> C) Prescription drugs
RATIONALE:
Medicare Part D is the prescription drug benefit. It is offered through private
3
, insurance companies that contract with CMS. Part D plans help cover the
cost of prescription medications and are available as standalone plans or as
part of Medicare Advantage plans that include drug coverage.
QUESTION 7
What is the Initial Enrollment Period (IEP) for Medicare?
A) A 6-month period before and after turning 65
B) A 7-month period that includes the 3 months before, the month of, and 3
months after turning 65
C) A 6-month period after turning 65
D) A 12-month period before and after turning 65
>>> B) A 7-month period that includes the 3 months before, the month of,
and 3 months after turning 65
RATIONALE:
The Initial Enrollment Period is 7 months total: the 3 months before the
month of a person's 65th birthday, the month they turn 65, and the 3
months after. Enrolling during this window ensures coverage begins on time
without penalties. Enrolling in the first 3 months starts coverage on the 1st
of the birthday month.
QUESTION 8
What is the General Enrollment Period (GEP) for Medicare Part B?
A) January 1 to March 31 each year
B) April 1 to June 30 each year
C) October 15 to December 7 each year
D) January 1 to February 14 each year
>>> A) January 1 to March 31 each year
RATIONALE:
4
