UHC Medicare Basics Test EXAM
Questions & Answers
which of the following options or drug utilization management UM
rules select three - ANSWER- quantity limit
prior authorization
step therapy
formulary is defined as - ANSWER- Alyssa medications covered
within the benefit plan based on CMS guidelines and develop in
collaboration with physicians and pharmacists
the new MACRA legislation which went into effect January 1st 2020
applies to all carriers offering Medicare supplement plans -
ANSWER- true
Joseph has original Medicare And was a patient in hospital last week
what part of Medicare helps cover the cost to the inpatient hospital
stay - ANSWER- part A
What must be explained to consumers enrolling in an HMO health
maintenance organization MA plan select three - ANSWER- in most
cases they will pay the entire cost of the service if they see an out of
network provider
they must see contract in network providers in order to receive
coverage under the plan
,the exception to the provider network requirement is emergency visits
urgent care and renal dialysis services which can be obtained from out
of network providers
which of the following are MA plans that focus on using network
providers to maximize the benefits and reduce out of network
expenses - ANSWER- HMO POS PPO
a government program offered only through a private insurance
company or other private company approved by Medicare that
provides prescription drug coverage describes which of the following
- ANSWER- Medicare Part D
which of the following best describes the late enrollment penalty LEP
- ANSWER- the amount added to the members monthly plan
premium if they did not enroll in a Medicare Advantage plan with
Part D benefits or standalone prescription drug plan when they were
first eligible for Medicare parts A and or B or went without creditable
prescription drug coverage for 60 three continuous days or more
how does a consumer who qualifies for low income subsidy receive
financial assistance for their part of Medicare Part D costs -
ANSWER- through subsidies such as lower or no monthly plan
premiums an lower or no copayments
and states where Medicare supplement insurance underwriting criteria
can apply all the following underwriting criteria apply except -
ANSWER- most consumers who are switching from another
Medicare supplement plan are entitled to guaranteed issue and
therefore are not subject to underwriting
, which of the following is not true about the Medicare access and CVP
reauthorization act of 2015 MACRA impact a plan C&F - ANSWER-
consumers already enrolled in playing C or F are required to change
plans
which of the following is not true of Medicare supplement insurance
plans - ANSWER- to see a specialist insured members must obtain
referrals from a primary care physician
OR
insured members must have their care coordinated through a primary
care physician
which statement is true about a member of Medicare Advantage MA
plan who wants to enroll in a Medicare supplement insurance plan -
ANSWER- when a consumer enrolls in a Medicare supplement
insurance plan he/she is not automatically disenrolled from his/her
plan
being 65 or older being under 65 years of age with certain disabilities
for more than 20 four months and being any age with E SRD or a LS
or each eligibility requirements for which program - ANSWER-
original Medicare
which of the following defines a Medicare Advantage MA plan -
ANSWER- MA plans are healthy plan options approved by Medicare
and offered by private insurance companies
Questions & Answers
which of the following options or drug utilization management UM
rules select three - ANSWER- quantity limit
prior authorization
step therapy
formulary is defined as - ANSWER- Alyssa medications covered
within the benefit plan based on CMS guidelines and develop in
collaboration with physicians and pharmacists
the new MACRA legislation which went into effect January 1st 2020
applies to all carriers offering Medicare supplement plans -
ANSWER- true
Joseph has original Medicare And was a patient in hospital last week
what part of Medicare helps cover the cost to the inpatient hospital
stay - ANSWER- part A
What must be explained to consumers enrolling in an HMO health
maintenance organization MA plan select three - ANSWER- in most
cases they will pay the entire cost of the service if they see an out of
network provider
they must see contract in network providers in order to receive
coverage under the plan
,the exception to the provider network requirement is emergency visits
urgent care and renal dialysis services which can be obtained from out
of network providers
which of the following are MA plans that focus on using network
providers to maximize the benefits and reduce out of network
expenses - ANSWER- HMO POS PPO
a government program offered only through a private insurance
company or other private company approved by Medicare that
provides prescription drug coverage describes which of the following
- ANSWER- Medicare Part D
which of the following best describes the late enrollment penalty LEP
- ANSWER- the amount added to the members monthly plan
premium if they did not enroll in a Medicare Advantage plan with
Part D benefits or standalone prescription drug plan when they were
first eligible for Medicare parts A and or B or went without creditable
prescription drug coverage for 60 three continuous days or more
how does a consumer who qualifies for low income subsidy receive
financial assistance for their part of Medicare Part D costs -
ANSWER- through subsidies such as lower or no monthly plan
premiums an lower or no copayments
and states where Medicare supplement insurance underwriting criteria
can apply all the following underwriting criteria apply except -
ANSWER- most consumers who are switching from another
Medicare supplement plan are entitled to guaranteed issue and
therefore are not subject to underwriting
, which of the following is not true about the Medicare access and CVP
reauthorization act of 2015 MACRA impact a plan C&F - ANSWER-
consumers already enrolled in playing C or F are required to change
plans
which of the following is not true of Medicare supplement insurance
plans - ANSWER- to see a specialist insured members must obtain
referrals from a primary care physician
OR
insured members must have their care coordinated through a primary
care physician
which statement is true about a member of Medicare Advantage MA
plan who wants to enroll in a Medicare supplement insurance plan -
ANSWER- when a consumer enrolls in a Medicare supplement
insurance plan he/she is not automatically disenrolled from his/her
plan
being 65 or older being under 65 years of age with certain disabilities
for more than 20 four months and being any age with E SRD or a LS
or each eligibility requirements for which program - ANSWER-
original Medicare
which of the following defines a Medicare Advantage MA plan -
ANSWER- MA plans are healthy plan options approved by Medicare
and offered by private insurance companies
