WELLCARE ACT MASTERY FINAL PAPER 2025/2026
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Members who have LIS and enroll in other plans will have a premium to pay
regardless of the level of LIS the member is granted.
True
False - ✔✔True
✔✔*Wellcare's _____ plan is designed for Low-Income Subsidy members.
a. Classic
b. Value Plus
c. Value Script - ✔✔a. Classic
*NOT c. Value Script
✔✔Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part
D plan premiums.
True
False - ✔✔False
✔✔Enrollment applications must be received by Wellcare no later than ___ calendar
day(s) following receipt from the beneficiary.
a. 1
b. 3
c. 5
d. 7 - ✔✔a. 1
✔✔If a requested effective date is available for the special election period being
selected, ensure you are requesting a date within the correct timeframe for the member
based on their eligibility date or change date needed.
True
False - ✔✔True
✔✔Once the enrollment is completed, you can save a copy of the application for your
reference.
True
False - ✔✔False
✔✔Members who fail to pay the required premiums before the end of the grace period
(Wellcare has a three-month grace period) will be terminated.
True
False - ✔✔True
,✔✔When completing an enrollment, be sure to use the correct enrollment application
for the desired plan year.
True
False - ✔✔
✔✔The Mastery Exam will lock for a period of 48 hours after each failed attempt.
True
False - ✔✔False
✔✔CustomPoint sales material order dates will be posted on Wellcare.com.
True
False - ✔✔False
✔✔Brokers/Agents may be investigated after being suspected of noncompliant activity
reported through a:
(Select all that apply.)
a. Complaint Tracking Module (CTM)
b. Yelp Review
c. Grievance
d. Secret Shop Finding - ✔✔a. Complaint Tracking Module (CTM)
c. Grievance
d. Secret Shop Finding
✔✔When explaining the provider network for D-SNPs and C-SNPs:
(Select all that apply.)
a. Avoid submitting applications with no primary care provider (PCP) to assist these
higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
c. Not explaining the provider network is a fundamental task during the enrollment
process.
d. None of these - ✔✔a. Avoid submitting applications with no primary care provider
(PCP) to assist these higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
✔✔Noting the correct enrollment period on enrollment applications helps in preventing
delayed enrollment processing.
True
False - ✔✔True
✔✔A grievance request, or any evidence concerning a grievance, must be filed orally or
in writing no later than _____ calendar days from the date of the event or the date the
member is made aware of the issue.
, a. 30
b. 45
c. 60
d. 90 - ✔✔c. 60
✔✔When discussing prescription drug coverage, you should:
(Select all that apply.)
a. Explain how to use the formulary to look up limitations and exclusions (e.g., step
therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception. - ✔✔a. Explain how to use the formulary to
look up limitations and exclusions (e.g., step therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception.
✔✔Which of the following actions are you required to do when contacted regarding an
allegation of noncompliant activity?
a. Speak with the investigator as quickly as possible.
b. Answer all questions honestly and completely.
c. Offer information and documents important to the investigation.
d. All of these - ✔✔d. All of these
✔✔Which is an example of a top beneficiary complaint that affects Star Ratings?
a. The beneficiary was enrolled in the correct plan.
b. The provider was in-network and contracted with the selected plan.
c. The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
d. The beneficiary enrolled by the enrollment deadline. - ✔✔c. The beneficiary did not
understand that enrolling in a Wellcare plan would change their current Medicare
Advantage plan.
✔✔______ events are designed to inform the people who attend about Medicare
Advantage, Prescription Drug, or other Medicare programs without going into the
specifics of a particular carrier.
a. Informal Sales
b. Formal Sales
c. Educational - ✔✔c. Educational
✔✔Marketing benefits in a service area where those benefits are not available is
prohibited and considered misleading unless that is unavoidable because of
local/regional or media use.
QUESTIONS WITH SOLUTIONS GRADED A+
✔✔Members who have LIS and enroll in other plans will have a premium to pay
regardless of the level of LIS the member is granted.
True
False - ✔✔True
✔✔*Wellcare's _____ plan is designed for Low-Income Subsidy members.
a. Classic
b. Value Plus
c. Value Script - ✔✔a. Classic
*NOT c. Value Script
✔✔Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part
D plan premiums.
True
False - ✔✔False
✔✔Enrollment applications must be received by Wellcare no later than ___ calendar
day(s) following receipt from the beneficiary.
a. 1
b. 3
c. 5
d. 7 - ✔✔a. 1
✔✔If a requested effective date is available for the special election period being
selected, ensure you are requesting a date within the correct timeframe for the member
based on their eligibility date or change date needed.
True
False - ✔✔True
✔✔Once the enrollment is completed, you can save a copy of the application for your
reference.
True
False - ✔✔False
✔✔Members who fail to pay the required premiums before the end of the grace period
(Wellcare has a three-month grace period) will be terminated.
True
False - ✔✔True
,✔✔When completing an enrollment, be sure to use the correct enrollment application
for the desired plan year.
True
False - ✔✔
✔✔The Mastery Exam will lock for a period of 48 hours after each failed attempt.
True
False - ✔✔False
✔✔CustomPoint sales material order dates will be posted on Wellcare.com.
True
False - ✔✔False
✔✔Brokers/Agents may be investigated after being suspected of noncompliant activity
reported through a:
(Select all that apply.)
a. Complaint Tracking Module (CTM)
b. Yelp Review
c. Grievance
d. Secret Shop Finding - ✔✔a. Complaint Tracking Module (CTM)
c. Grievance
d. Secret Shop Finding
✔✔When explaining the provider network for D-SNPs and C-SNPs:
(Select all that apply.)
a. Avoid submitting applications with no primary care provider (PCP) to assist these
higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
c. Not explaining the provider network is a fundamental task during the enrollment
process.
d. None of these - ✔✔a. Avoid submitting applications with no primary care provider
(PCP) to assist these higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
✔✔Noting the correct enrollment period on enrollment applications helps in preventing
delayed enrollment processing.
True
False - ✔✔True
✔✔A grievance request, or any evidence concerning a grievance, must be filed orally or
in writing no later than _____ calendar days from the date of the event or the date the
member is made aware of the issue.
, a. 30
b. 45
c. 60
d. 90 - ✔✔c. 60
✔✔When discussing prescription drug coverage, you should:
(Select all that apply.)
a. Explain how to use the formulary to look up limitations and exclusions (e.g., step
therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception. - ✔✔a. Explain how to use the formulary to
look up limitations and exclusions (e.g., step therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception.
✔✔Which of the following actions are you required to do when contacted regarding an
allegation of noncompliant activity?
a. Speak with the investigator as quickly as possible.
b. Answer all questions honestly and completely.
c. Offer information and documents important to the investigation.
d. All of these - ✔✔d. All of these
✔✔Which is an example of a top beneficiary complaint that affects Star Ratings?
a. The beneficiary was enrolled in the correct plan.
b. The provider was in-network and contracted with the selected plan.
c. The beneficiary did not understand that enrolling in a Wellcare plan would change
their current Medicare Advantage plan.
d. The beneficiary enrolled by the enrollment deadline. - ✔✔c. The beneficiary did not
understand that enrolling in a Wellcare plan would change their current Medicare
Advantage plan.
✔✔______ events are designed to inform the people who attend about Medicare
Advantage, Prescription Drug, or other Medicare programs without going into the
specifics of a particular carrier.
a. Informal Sales
b. Formal Sales
c. Educational - ✔✔c. Educational
✔✔Marketing benefits in a service area where those benefits are not available is
prohibited and considered misleading unless that is unavoidable because of
local/regional or media use.
