UHC certification EXAM 154 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+

UHC certification EXAM 154 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ 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 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 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? - ANSWERMedicare 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 Can a member with a POS plan see a specialist? - ANSWER- Yes, but they may have to pay a higher cost, and there coverage limits With a PFFS plan, can a member seek treatment from any medicare eligible provider who agrees to accept the plans conditions and payment rates? - ANSWER- Yes Does a PCP need to be selected with a PFFS plan? - ANSWER- No What is the only plan to offer non-network PFFS plans? - ANSWER- UHC What are SNP's for? ( Dual SNP) - ANSWER- People who have both medicare and Medicaid Institutional SNP? - ANSWER- Nursing homes Chronic condition SNP? - ANSWER- people who have certain chronic medical conditions MSA? - ANSWER- Medical savings account What does a MSA do? - ANSWER- Combines a high deductible medicare advantage plan and a bank account How does MSA plans work? - ANSWER- the plan deposits money from emdicare in the account which can then be used to pay for medical expenses until their deductible is met Does UHC currently offer a MSA? - ANSWER- no MA plans include some key features such as? - ANSWER- Prescription drug coverage, PCPs and a OOP maxium