UHC certification 157 complete
solutions.
UHC certification 157 complete
solutions.
Medicare - ANSWER Federal health insurance program
Medicare is administered by whom? - ANSWER CMS ( Centers for medicare and medicaid services)
Parts A & B of medicare are - ANSWER federal health insurance program referred to as original medicare
Part A? - ANSWER Hospital insurance
Part B? - ANSWER Medical insurance
What doesnt medicare cover? - ANSWER routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
Part C? - ANSWER Medicare Advantage Plans
MA covers? - ANSWER Part A &B coverage, and some part D coverage
MA plans are not? - ANSWER Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWER MADP
do MAP's have a annual maximum OOP maximum that limits the amount of money a member must
spend every year for covered services? - ANSWER YES
MA plans integrate what type of additonal coverage? - ANSWER part D prescription drug coverage
,UHC certification 157 complete
solutions.
If a customer wants to keep their stand alone prescription drug plan, what may the customer want to
enroll in? - ANSWER MA-only PFFS plan
What is a stand alone drug plan called? - ANSWER PDP
WHat is PFFS? - ANSWER Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or
hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want because it gives them freedom to
access doctors that may not be in their network? - ANSWER PFFS plan
Do HMO's require referals? - ANSWER Yes
Do PPO's require a referal? - ANSWER No
When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? -
ANSWER MA plan
When a customer is enrolled in a MA plan, they must continue paying their premiums for what other
plan? - ANSWER Part B
MA plans have a maxium annual limit on OOP costs called a? - ANSWER MOOP amount ( Maxium out of
pocket)
When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or
PDP( prescription drug plan) in which they are enrolled as of the new plans_____? - ANSWER effective
date
, UHC certification 157 complete
solutions.
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? - ANSWER
Stand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWER Cancel in writing their
medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been
approved.
Medicare supplement insurance policies cannot be used in conjunction with what type of plan? -
ANSWER MA plan
A medicare supplement insurance plan helps to cover some of the OOP costs associated with? -
ANSWER original medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? - ANSWER
MA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? - ANSWER NO
Can a customer call to terminate their Med Sup plan? - ANSWER no it must be done in writing
What are the different types of MA plans? - ANSWER HMO, POS, PPO, RPPO, PFFS, SNP, and MSA
For an HMO, they customer must us IN network providers, what are the exceptions to their rule? -
ANSWER Emergencies, Urgent care, and renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? -
ANSWER Yes
In a POS plan, does a member need a referral from their PCP to see a specialist? - ANSWER yes
solutions.
UHC certification 157 complete
solutions.
Medicare - ANSWER Federal health insurance program
Medicare is administered by whom? - ANSWER CMS ( Centers for medicare and medicaid services)
Parts A & B of medicare are - ANSWER federal health insurance program referred to as original medicare
Part A? - ANSWER Hospital insurance
Part B? - ANSWER Medical insurance
What doesnt medicare cover? - ANSWER routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
Part C? - ANSWER Medicare Advantage Plans
MA covers? - ANSWER Part A &B coverage, and some part D coverage
MA plans are not? - ANSWER Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWER MADP
do MAP's have a annual maximum OOP maximum that limits the amount of money a member must
spend every year for covered services? - ANSWER YES
MA plans integrate what type of additonal coverage? - ANSWER part D prescription drug coverage
,UHC certification 157 complete
solutions.
If a customer wants to keep their stand alone prescription drug plan, what may the customer want to
enroll in? - ANSWER MA-only PFFS plan
What is a stand alone drug plan called? - ANSWER PDP
WHat is PFFS? - ANSWER Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or
hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want because it gives them freedom to
access doctors that may not be in their network? - ANSWER PFFS plan
Do HMO's require referals? - ANSWER Yes
Do PPO's require a referal? - ANSWER No
When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? -
ANSWER MA plan
When a customer is enrolled in a MA plan, they must continue paying their premiums for what other
plan? - ANSWER Part B
MA plans have a maxium annual limit on OOP costs called a? - ANSWER MOOP amount ( Maxium out of
pocket)
When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or
PDP( prescription drug plan) in which they are enrolled as of the new plans_____? - ANSWER effective
date
, UHC certification 157 complete
solutions.
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? - ANSWER
Stand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWER Cancel in writing their
medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been
approved.
Medicare supplement insurance policies cannot be used in conjunction with what type of plan? -
ANSWER MA plan
A medicare supplement insurance plan helps to cover some of the OOP costs associated with? -
ANSWER original medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? - ANSWER
MA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? - ANSWER NO
Can a customer call to terminate their Med Sup plan? - ANSWER no it must be done in writing
What are the different types of MA plans? - ANSWER HMO, POS, PPO, RPPO, PFFS, SNP, and MSA
For an HMO, they customer must us IN network providers, what are the exceptions to their rule? -
ANSWER Emergencies, Urgent care, and renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? -
ANSWER Yes
In a POS plan, does a member need a referral from their PCP to see a specialist? - ANSWER yes
