UHC certifications Exam 94 Questions and Answers with Complete Solutions 2025 Rated A+

Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct Answer: Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility requirements. Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? Correct Answer: When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan. Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? Correct Answer: Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) Correct Answer: 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits. 2. MA Plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? Correct Answer: Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? Correct Answer: Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? Correct Answer: (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. lOMoAR cPSD| What is true about Medicare supplement open enrollment? Correct Answer: (INCORRECT) A consumer who waits to enroll in Medicare Part B until age 66 or older cannot qualify for Medicare Supplement Open Enrollment. (INCORRECT) It is the only time a consumer is eligible to purchase a Medicare Supplement Insurance Plan. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? Correct Answer: The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? Correct Answer: Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member must cancel their Medicare Supplement Insurance policy according to their carrier's rules. Which of the following best defines Medicare Part D? Correct Answer: It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. Which of the following is a fact about Medicare Prescription Drug Plans? Correct Answer: To enroll, member must be in plans service area What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) Correct Answer: Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage Which of the following statements does NOT correctly define prescription drug stages? Correct Answer: A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. lOMoAR cPSD| Which of these statements is NOT true about the drug utilization management (UM) rules? Correct Answer: (INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UM rules What is the amount added to the member's monthly plan premium if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days? Correct Answer: Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Correct Answer: Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: Correct Answer: A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? Correct Answer: Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. Correct Answer: True Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answer: (INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. Which of the following consumers are eligible for Medicare if other eligibility requirements are met? Correct Answer: Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) Correct Answer: An MA Plan is a health plan option approved by Medicare and offered by private insurance companies. lOMoAR cPSD| An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? Correct Answer: Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? Correct Answer: HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? Correct Answer: She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? Correct Answer: A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium Which of the following statements is true about eligibility requirements for stand- alone Medicare Prescription Drug Plans? Correct Answer: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? Correct Answer: They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? Correct Answer: Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? Correct Answer: Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone lOMoAR cPSD| prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for . Correct Answer: 63 or more continuous days Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Correct Answer: Through subsidies such as lower or no monthly plan premiums and lower or no copayments Which of the following lists drug tiers from least expensive cost share to most expensive cost share? Correct Answer: Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? Correct Answer: Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? Correct Answer: Insured members have the freedom to choose any doctor who accepts Medicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? Correct Answer: April 1 through October 31 Annual Election Period (AEP) is a time when. . . Correct Answer: Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Correct Answer: Mrs. Violet can access the Star Rating for a plan on M or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? Correct Answer: When the consumer consented to be contacted for sales activities and the permission has not yet expired. lOMoAR cPSD| Which statement is true about discussing benefits with the consumer before an enrollment? Correct Answer: The agent must accurately and completely disclose any benefits discussed. When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available for the consumer's email address? Correct Answer: The consumer/member would not receive plan related correspondence intended for him/her. The ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. Correct Answer: Statement of Understanding What is Scope of Appointment? Correct Answer: The agreement obtained from the consumer to that identifies the scope of products that can be discussed at a personal/individual marketing appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? Correct Answer: Jane should ask Albert if someone, such as an Authorized Legal Representative, helps him make health care or insurance-related decisions and should be present. Melanie is currently enrolled in a Medicare Supplement Insurance Plan and a PDP. Assuming she has a valid election period, what would happen if she enrolled in an HMO MAPD plan? Correct Answer: (INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. Medicare Advantage (MA) organization must disenroll a member from an MA plan in which situation? Correct Answer: The member loses entitlement to either Medicare Part A or Part B. Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? Correct Answer: Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. lOMoAR cPSD| In what product should agents enroll consumers? Correct Answer: A product that is suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? Correct Answer: Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? Correct Answer: AARP endorses UnitedHealthcare MA, PDP and Medicare Supplement plans. AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is . Correct Answer: Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) Correct Answer: Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare? Correct Answer: Yes, if the consumer is enrolling in a Medicare Supplement Plan. How many status levels are in the Authorized to Offer Program? Correct Answer: 2 According to AARP, there are how many individual AARP members? Correct Answer: Nearly 37 million Which of the following statements about AARP are TRUE? (Select 2) Correct Answer: The AARP motto is to serve, not be served.