UHC MEDICARE BASICS STUDY GUIDE 2025/2026
ANSWERS AND QUESTIONS GRADED A+
✔✔Which of the following statements is NOT true about the Coverage Gap? - ✔✔All
members reach the Coverage Gap.
✔✔Which of these statements is NOT true about the drug utilization management (UM)
rules? - ✔✔
✔✔Which of the following best describes the Late Enrollment Penalty (LEP)? - ✔✔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.
✔✔Through which means is financial assistance offered to a consumer who qualifies for
Low Income Subsidy for their part of Medicare Part D costs? - ✔✔Through subsidies
such as lower or no monthly plan premiums and lower or no copayments.
✔✔Formulary is defined as: - ✔✔A list of medications covered within the benefit plan,
based on CMS guidelines and developed in collaboration with physicians and
pharmacists.
✔✔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. -
✔✔True
✔✔ In which two parts of Medicare is enrollment generally automatic for eligible
consumers who are receiving Social Security benefits, UNLESS they choose to delay
their coverage? - ✔✔Parts A and B
✔✔Which statement is true about members of a Medicare Advantage (MA) Plan who
want to enroll in a Medicare Supplement Insurance Plan? - ✔✔The consumer must be
in a valid MA election or disenrollment period.
✔✔Provided other eligibility requirements are met, who is eligible for Medicare? -
✔✔Consumers age 65 or older, consumers under 65 years of age with a qualifying
disability and consumers of all ages with ESRD or ALS who are receiving Social
Security Disability Insurance (SSDI) for ALS.
✔✔Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - ✔✔-An
MA Plan is a health plan option approved by Medicare and offered by private insurance
companies.
-An MA Plan is part of Medicare and is also called Part C.
, -An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and
Part B) and often includes Medicare prescription drug coverage (Part D).
✔✔To be eligible for this plan type, consumers must meet the following requirements:
be entitled to Medicare Part A and enrolled in Part B, and reside in the plan's service
area. Which plan is being described? - ✔✔Medicare Advantage
✔✔Which of the following statements is correct about HMO MA Plans? - ✔✔Members
must receive covered services from contracted network providers with limited
exceptions.
✔✔Which of the following are MA Plans that focus on using network providers to
maximize the benefits and reduce out-of-network expenses? - ✔✔HMO, POS, PPO
✔✔When does Medicare Supplement Open Enrollment take place? - ✔✔During the first
six months a consumer is 65 or older and enrolled in Medicare Part B.
✔✔What costs count toward the out-of-pocket maximum for Medicare Advantage (MA)
Plans? - ✔✔The Out-of-Pocket Maximum includes costs the member pays for any
Medicare-covered Part A or B services but does not include the cost of any plan
premiums.
✔✔A consumer currently has Original Medicare and is enrolled in a stand-alone
Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan
that has integrated prescription drug coverage? - ✔✔The consumer will be
automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan
that has integrated prescription drug coverage
✔✔What is Medicare Part D? - ✔✔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 consumer is eligible for a stand-alone Medicare Prescription Drug Plan? -
✔✔Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the
plan's service area.
✔✔A consumer with only Part A residing in the plan's service area can enroll in which
plan type to get Part D coverage? - ✔✔A stand-alone Part D Plan.
✔✔Which of the following statements accurately describes a prescription drug stage? -
✔✔Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
ANSWERS AND QUESTIONS GRADED A+
✔✔Which of the following statements is NOT true about the Coverage Gap? - ✔✔All
members reach the Coverage Gap.
✔✔Which of these statements is NOT true about the drug utilization management (UM)
rules? - ✔✔
✔✔Which of the following best describes the Late Enrollment Penalty (LEP)? - ✔✔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.
✔✔Through which means is financial assistance offered to a consumer who qualifies for
Low Income Subsidy for their part of Medicare Part D costs? - ✔✔Through subsidies
such as lower or no monthly plan premiums and lower or no copayments.
✔✔Formulary is defined as: - ✔✔A list of medications covered within the benefit plan,
based on CMS guidelines and developed in collaboration with physicians and
pharmacists.
✔✔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. -
✔✔True
✔✔ In which two parts of Medicare is enrollment generally automatic for eligible
consumers who are receiving Social Security benefits, UNLESS they choose to delay
their coverage? - ✔✔Parts A and B
✔✔Which statement is true about members of a Medicare Advantage (MA) Plan who
want to enroll in a Medicare Supplement Insurance Plan? - ✔✔The consumer must be
in a valid MA election or disenrollment period.
✔✔Provided other eligibility requirements are met, who is eligible for Medicare? -
✔✔Consumers age 65 or older, consumers under 65 years of age with a qualifying
disability and consumers of all ages with ESRD or ALS who are receiving Social
Security Disability Insurance (SSDI) for ALS.
✔✔Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - ✔✔-An
MA Plan is a health plan option approved by Medicare and offered by private insurance
companies.
-An MA Plan is part of Medicare and is also called Part C.
, -An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and
Part B) and often includes Medicare prescription drug coverage (Part D).
✔✔To be eligible for this plan type, consumers must meet the following requirements:
be entitled to Medicare Part A and enrolled in Part B, and reside in the plan's service
area. Which plan is being described? - ✔✔Medicare Advantage
✔✔Which of the following statements is correct about HMO MA Plans? - ✔✔Members
must receive covered services from contracted network providers with limited
exceptions.
✔✔Which of the following are MA Plans that focus on using network providers to
maximize the benefits and reduce out-of-network expenses? - ✔✔HMO, POS, PPO
✔✔When does Medicare Supplement Open Enrollment take place? - ✔✔During the first
six months a consumer is 65 or older and enrolled in Medicare Part B.
✔✔What costs count toward the out-of-pocket maximum for Medicare Advantage (MA)
Plans? - ✔✔The Out-of-Pocket Maximum includes costs the member pays for any
Medicare-covered Part A or B services but does not include the cost of any plan
premiums.
✔✔A consumer currently has Original Medicare and is enrolled in a stand-alone
Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan
that has integrated prescription drug coverage? - ✔✔The consumer will be
automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan
that has integrated prescription drug coverage
✔✔What is Medicare Part D? - ✔✔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 consumer is eligible for a stand-alone Medicare Prescription Drug Plan? -
✔✔Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the
plan's service area.
✔✔A consumer with only Part A residing in the plan's service area can enroll in which
plan type to get Part D coverage? - ✔✔A stand-alone Part D Plan.
✔✔Which of the following statements accurately describes a prescription drug stage? -
✔✔Starting in 2024, the catastrophic coverage stage is when the member will pay
nothing for covered drugs for the remainder of the plan year.
