WELLCARE ACT MASTERY EXAMINATION 2025/2026
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Which will be Wellcare's Preferred Mail Order pharmacy? - ✔✔Express Scripts®
Pharmacy
✔✔The Medicare Prescription Payment Plan is a payment option that helps manage
out-of-pocket (OOP) Part B costs by allowing members who opt-in to spread costs
throughout the benefit year. - ✔✔FALSE
✔✔All three Prescription Drug Plans (PDPs) will offer a five-tier formulary design. -
✔✔TRUE
✔✔The _________ plan is expected to continue to offer members a cost-effective
option, with one of the lowest premiums in the nation! - ✔✔Value Script
✔✔Wellcare Mutual of Omaha co-branded plans are offered in _____ states. - ✔✔Five
✔✔Wellcare offers Medicare Advantage (MA) products to meet the needs of a variety of
beneficiaries. We offer: - ✔✔All of these
✔✔All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug
coverage include a $0 copay Tier 6 at all in-network pharmacy locations. - ✔✔TRUE
✔✔Only members with a standalone Prescription Drug Plan (PDP) are eligible to use
the Medicare Prescription Payment Plan option. - ✔✔FALSE
✔✔As part of Centene's Ethics and Compliance program, Centene requires all agents
to review and agree to its Business Ethics and Code of Conduct Policy. - ✔✔TRUE
✔✔Disciplinary actions stemming from the result of a compliance allegation are always
progressive. - ✔✔FALSE
✔✔Self-reporting of a compliance issue must be made to Corporate Compliance or to a
Health Plan Sales Leader and must indicate: - ✔✔All of these
✔✔A Scope of Appointment (SOA) is valid _____ following the beneficiary's signature
date. - ✔✔12 months
✔✔Members have several options to pay plan premiums. The best option to ensure
regular and timely payments are: - ✔✔All of these
, ✔✔Names and/or logos of provider co-branding partners can be displayed on marketing
materials, as long as the current and approved logos are used. - ✔✔FALSE
✔✔Failure to inform a beneficiary that a trusted provider is out-of-network or is not
available in the newly selected plan can cause a sales allegation. - ✔✔TRUE
✔✔Best practices to keep in mind for Dual Eligible Special Needs Plan (D-SNP) and
Chronic Condition Special Needs Plan (C-SNP) enrollments include the following:
(Select all that apply.) - ✔✔If a member is not connected to a primary care provider
(PCP), always encourage and assist with connecting them to an in-network doctor.
Avoid submitting applications with no PCP to assist these higher-risk members.
✔✔When prospective Wellcare members check online for the status of their submitted
application, which element is optional? - ✔✔Confirmation Number
✔✔You can help prevent grievances by: (Select all that apply.) - ✔✔Always confirming
availability of the beneficiary's primary and specialist providers by using the provider
search tool available on the plan's website.
Always using plan materials to clearly explain plan benefits and cost (including
medications) and check for understanding.
Always confirming a beneficiary's intent to enroll before accepting their enrollment
application.
✔✔Which is an example of a top beneficiary complaint that affects Star Ratings? -
✔✔The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
✔✔Any request or distribution of PHI should contain only the minimum amount of PHI
required to complete the intended task. - ✔✔TRUE
✔✔Starting in 2025, a member may move through THREE benefit stages during the
plan year. Which benefit stage will no longer exist? - ✔✔Coverage gap
✔✔Members who have LIS and enroll in a plan other than Wellcare's Classic plan will
pay a premium regardless of LIS subsidy status. - ✔✔TRUE
✔✔For 2025, Wellcare will offer a Value-Based Insurance Design (VBID) model on
select Dual Eligible Special Needs Plans (D-SNPs) that include $0 deductible and $0
copays for covered prescriptions. - ✔✔TRUE
✔✔Final 2025 plan and benefit information may be discussed with beneficiaries on or
before September 30, 2024. - ✔✔FALSE
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Which will be Wellcare's Preferred Mail Order pharmacy? - ✔✔Express Scripts®
Pharmacy
✔✔The Medicare Prescription Payment Plan is a payment option that helps manage
out-of-pocket (OOP) Part B costs by allowing members who opt-in to spread costs
throughout the benefit year. - ✔✔FALSE
✔✔All three Prescription Drug Plans (PDPs) will offer a five-tier formulary design. -
✔✔TRUE
✔✔The _________ plan is expected to continue to offer members a cost-effective
option, with one of the lowest premiums in the nation! - ✔✔Value Script
✔✔Wellcare Mutual of Omaha co-branded plans are offered in _____ states. - ✔✔Five
✔✔Wellcare offers Medicare Advantage (MA) products to meet the needs of a variety of
beneficiaries. We offer: - ✔✔All of these
✔✔All Traditional Medicare Advantage Prescription Drug (MAPD) plans with drug
coverage include a $0 copay Tier 6 at all in-network pharmacy locations. - ✔✔TRUE
✔✔Only members with a standalone Prescription Drug Plan (PDP) are eligible to use
the Medicare Prescription Payment Plan option. - ✔✔FALSE
✔✔As part of Centene's Ethics and Compliance program, Centene requires all agents
to review and agree to its Business Ethics and Code of Conduct Policy. - ✔✔TRUE
✔✔Disciplinary actions stemming from the result of a compliance allegation are always
progressive. - ✔✔FALSE
✔✔Self-reporting of a compliance issue must be made to Corporate Compliance or to a
Health Plan Sales Leader and must indicate: - ✔✔All of these
✔✔A Scope of Appointment (SOA) is valid _____ following the beneficiary's signature
date. - ✔✔12 months
✔✔Members have several options to pay plan premiums. The best option to ensure
regular and timely payments are: - ✔✔All of these
, ✔✔Names and/or logos of provider co-branding partners can be displayed on marketing
materials, as long as the current and approved logos are used. - ✔✔FALSE
✔✔Failure to inform a beneficiary that a trusted provider is out-of-network or is not
available in the newly selected plan can cause a sales allegation. - ✔✔TRUE
✔✔Best practices to keep in mind for Dual Eligible Special Needs Plan (D-SNP) and
Chronic Condition Special Needs Plan (C-SNP) enrollments include the following:
(Select all that apply.) - ✔✔If a member is not connected to a primary care provider
(PCP), always encourage and assist with connecting them to an in-network doctor.
Avoid submitting applications with no PCP to assist these higher-risk members.
✔✔When prospective Wellcare members check online for the status of their submitted
application, which element is optional? - ✔✔Confirmation Number
✔✔You can help prevent grievances by: (Select all that apply.) - ✔✔Always confirming
availability of the beneficiary's primary and specialist providers by using the provider
search tool available on the plan's website.
Always using plan materials to clearly explain plan benefits and cost (including
medications) and check for understanding.
Always confirming a beneficiary's intent to enroll before accepting their enrollment
application.
✔✔Which is an example of a top beneficiary complaint that affects Star Ratings? -
✔✔The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
✔✔Any request or distribution of PHI should contain only the minimum amount of PHI
required to complete the intended task. - ✔✔TRUE
✔✔Starting in 2025, a member may move through THREE benefit stages during the
plan year. Which benefit stage will no longer exist? - ✔✔Coverage gap
✔✔Members who have LIS and enroll in a plan other than Wellcare's Classic plan will
pay a premium regardless of LIS subsidy status. - ✔✔TRUE
✔✔For 2025, Wellcare will offer a Value-Based Insurance Design (VBID) model on
select Dual Eligible Special Needs Plans (D-SNPs) that include $0 deductible and $0
copays for covered prescriptions. - ✔✔TRUE
✔✔Final 2025 plan and benefit information may be discussed with beneficiaries on or
before September 30, 2024. - ✔✔FALSE
