UHC (UnitedHealthcare) Exam Study Guide
2025/2026 | Actual Questions and Verified
Correct Answers | Graded A+ | Latest Version
Section 1: Medicare Advantage (Part C) & Part D
1. What is the primary purpose of the Annual Election Period (AEP)?
A) To enroll in a Medicare plan for the first time.
B) To make any changes to existing Medicare coverage.
C) To change from one Medicare Advantage plan to another, or to switch
between Medicare Advantage and Original Medicare.
D) Only for individuals who receive Extra Help.
2. During which period can a Medicare beneficiary switch from a Medicare
Advantage plan back to Original Medicare?
A) Initial Coverage Election Period
B) Medicare Advantage Open Enrollment Period (Jan 1 - Mar 31)
C) Annual Election Period
D) Special Election Period
3. What is a key difference between a Medicare Supplement (Medigap) plan
and a Medicare Advantage plan?
A) Medigap plans are provided by private companies and often include Part D.
B) Medicare Advantage plans replace Original Medicare, while Medigap plans
work alongside it.
C) Medigap plans have network restrictions like HMOs.
D) Medicare Advantage plans do not have a maximum out-of-pocket limit.
4. The "Donut Hole" or Coverage Gap is officially known as what?
A) The Initial Deductible Phase
B) The Catastrophic Coverage Phase
C) The Coverage Gap
D) The Pre-Coverage Phase
,5. What happens when a member reaches the Catastrophic Coverage phase in
a Part D plan?
A) They pay 100% of their drug costs.
B) Their coverage resets for the year.
C) They pay a significantly reduced coinsurance or copayment for covered
drugs.
D) They are automatically enrolled in a new plan.
6. Which of the following is NOT typically a requirement for a Special
Election Period (SEP)?
A) Moving out of the plan's service area.
B) Losing employer-sponsored coverage.
C) Qualifying for Extra Help (LIS).
D) Simply wanting to pay a lower premium.
7. What is the maximum length of an Initial Coverage Election Period (ICEP)
for someone aging into Medicare?
A) 2 months before to 2 months after their 65th birthday month.
B) 3 months before, the month of, and 3 months after their 65th birthday
month.
C) 1 month before to 6 months after their 65th birthday month.
D) The entire calendar year they turn 65.
8. Which Medicare program helps pay for Part D costs for beneficiaries with
limited income and resources?
A) Medicaid
B) The Extra Help program (Low-Income Subsidy - LIS)
C) Medicare Savings Program
D) State Pharmaceutical Assistance Program
9. What type of Medicare Advantage plan typically has the most restrictive
network?
A) PPO (Preferred Provider Organization)
B) PFFS (Private Fee-for-Service)
C) HMO (Health Maintenance Organization)
D) HMO-POS (HMO Point-of-Service)
, 10. What is the main goal of the Health Risk Assessment (HRA) in a Medicare
Advantage plan?
A) To determine premium costs.
B) To identify member health needs and create a personalized care plan.
C) To approve all specialist referrals.
D) To replace the Annual Wellness Visit.
Section 2: Compliance, Ethics, and Regulations
11. What is agent/broker compensation primarily based on?
A) The health status of the members they enroll.
B) The number of complaints filed against them.
C) The number of eligible individuals they enroll in a plan, and those members
remaining in the plan.
D) The premium amount of the plan they sell.
12. "Scope of Appointment" (SOA) rules are designed to:
A) Limit the number of plans an agent can sell.
B) Ensure beneficiaries agree in advance to the products that will be discussed
during a sales meeting.
C) Define an agent's sales territory.
D) Schedule appointments with doctors.
13. When can an agent use "free lunch" seminars to market Medicare plans?
A) Never; they are prohibited.
B) Only if the event is educational and no plan-specific information is
presented.
C) Always, as long as the food value is under $50.
D) Only during the AEP.
14. What is a primary responsibility of a Medicare agent regarding a client's
personal information?
A) Share it with other agents to find the best plan.
B) Protect it according to HIPAA privacy and security rules.
2025/2026 | Actual Questions and Verified
Correct Answers | Graded A+ | Latest Version
Section 1: Medicare Advantage (Part C) & Part D
1. What is the primary purpose of the Annual Election Period (AEP)?
A) To enroll in a Medicare plan for the first time.
B) To make any changes to existing Medicare coverage.
C) To change from one Medicare Advantage plan to another, or to switch
between Medicare Advantage and Original Medicare.
D) Only for individuals who receive Extra Help.
2. During which period can a Medicare beneficiary switch from a Medicare
Advantage plan back to Original Medicare?
A) Initial Coverage Election Period
B) Medicare Advantage Open Enrollment Period (Jan 1 - Mar 31)
C) Annual Election Period
D) Special Election Period
3. What is a key difference between a Medicare Supplement (Medigap) plan
and a Medicare Advantage plan?
A) Medigap plans are provided by private companies and often include Part D.
B) Medicare Advantage plans replace Original Medicare, while Medigap plans
work alongside it.
C) Medigap plans have network restrictions like HMOs.
D) Medicare Advantage plans do not have a maximum out-of-pocket limit.
4. The "Donut Hole" or Coverage Gap is officially known as what?
A) The Initial Deductible Phase
B) The Catastrophic Coverage Phase
C) The Coverage Gap
D) The Pre-Coverage Phase
,5. What happens when a member reaches the Catastrophic Coverage phase in
a Part D plan?
A) They pay 100% of their drug costs.
B) Their coverage resets for the year.
C) They pay a significantly reduced coinsurance or copayment for covered
drugs.
D) They are automatically enrolled in a new plan.
6. Which of the following is NOT typically a requirement for a Special
Election Period (SEP)?
A) Moving out of the plan's service area.
B) Losing employer-sponsored coverage.
C) Qualifying for Extra Help (LIS).
D) Simply wanting to pay a lower premium.
7. What is the maximum length of an Initial Coverage Election Period (ICEP)
for someone aging into Medicare?
A) 2 months before to 2 months after their 65th birthday month.
B) 3 months before, the month of, and 3 months after their 65th birthday
month.
C) 1 month before to 6 months after their 65th birthday month.
D) The entire calendar year they turn 65.
8. Which Medicare program helps pay for Part D costs for beneficiaries with
limited income and resources?
A) Medicaid
B) The Extra Help program (Low-Income Subsidy - LIS)
C) Medicare Savings Program
D) State Pharmaceutical Assistance Program
9. What type of Medicare Advantage plan typically has the most restrictive
network?
A) PPO (Preferred Provider Organization)
B) PFFS (Private Fee-for-Service)
C) HMO (Health Maintenance Organization)
D) HMO-POS (HMO Point-of-Service)
, 10. What is the main goal of the Health Risk Assessment (HRA) in a Medicare
Advantage plan?
A) To determine premium costs.
B) To identify member health needs and create a personalized care plan.
C) To approve all specialist referrals.
D) To replace the Annual Wellness Visit.
Section 2: Compliance, Ethics, and Regulations
11. What is agent/broker compensation primarily based on?
A) The health status of the members they enroll.
B) The number of complaints filed against them.
C) The number of eligible individuals they enroll in a plan, and those members
remaining in the plan.
D) The premium amount of the plan they sell.
12. "Scope of Appointment" (SOA) rules are designed to:
A) Limit the number of plans an agent can sell.
B) Ensure beneficiaries agree in advance to the products that will be discussed
during a sales meeting.
C) Define an agent's sales territory.
D) Schedule appointments with doctors.
13. When can an agent use "free lunch" seminars to market Medicare plans?
A) Never; they are prohibited.
B) Only if the event is educational and no plan-specific information is
presented.
C) Always, as long as the food value is under $50.
D) Only during the AEP.
14. What is a primary responsibility of a Medicare agent regarding a client's
personal information?
A) Share it with other agents to find the best plan.
B) Protect it according to HIPAA privacy and security rules.
