UHC MEDICARE CERTIFICATION QUESTIONS
AND ANSWERS ALL VERIFIED
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare helps
cover the costs of his inpatient hospital stay? - CORRECT ANSWER-Part A
- CORRECT ANSWER-The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? - 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? - CORRECT ANSWER-MA Plans are
health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she meet?
(Select the two answers that apply.) - CORRECT ANSWER-Not have End Stage Renal Disease (permanent
kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan?
(Select 3) - CORRECT ANSWER-
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
Which is true about Medicare Supplement Open Enrollment? - CORRECT ANSWER-By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and enrolled in
Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? - CORRECT ANSWER-The OOP
maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-
covered health care services each year.
, 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? - CORRECT ANSWER-The consumer will be automatically disenrolled from their stand-alone
PDP upon enrollment in the MA Plan that has integrated prescription drug coverage
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: -
CORRECT ANSWER-Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Prescription Drug
Plans? - CORRECT ANSWER-A consumer must be entitled to Medicare Part A and/or enrolled in Medicare
Part B
What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they
meet all eligibility requirements)? (Select 2) - CORRECT ANSWER-
Which of the following statements is not true about the Coverage Gap? - CORRECT ANSWER-All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) - CORRECT
ANSWER-
Which of the following best describes the Late Enrollment Penalty (LEP)? - CORRECT ANSWER-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 continuous days or more.
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
Medications that are covered in a Plan's formulary have various levels of associated member cost-
sharing (copayments or coinsurance). What are these drug levels called? - CORRECT ANSWER-Drug tiers
AND ANSWERS ALL VERIFIED
Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare helps
cover the costs of his inpatient hospital stay? - CORRECT ANSWER-Part A
- CORRECT ANSWER-The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? - 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? - CORRECT ANSWER-MA Plans are
health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she meet?
(Select the two answers that apply.) - CORRECT ANSWER-Not have End Stage Renal Disease (permanent
kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan?
(Select 3) - CORRECT ANSWER-
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
Which is true about Medicare Supplement Open Enrollment? - CORRECT ANSWER-By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and enrolled in
Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? - CORRECT ANSWER-The OOP
maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-
covered health care services each year.
, 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? - CORRECT ANSWER-The consumer will be automatically disenrolled from their stand-alone
PDP upon enrollment in the MA Plan that has integrated prescription drug coverage
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: -
CORRECT ANSWER-Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Prescription Drug
Plans? - CORRECT ANSWER-A consumer must be entitled to Medicare Part A and/or enrolled in Medicare
Part B
What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they
meet all eligibility requirements)? (Select 2) - CORRECT ANSWER-
Which of the following statements is not true about the Coverage Gap? - CORRECT ANSWER-All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) - CORRECT
ANSWER-
Which of the following best describes the Late Enrollment Penalty (LEP)? - CORRECT ANSWER-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 continuous days or more.
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
Medications that are covered in a Plan's formulary have various levels of associated member cost-
sharing (copayments or coinsurance). What are these drug levels called? - CORRECT ANSWER-Drug tiers
