UHC Certification 2 Latest Versions Exam Questions
and Answers
Lisa turned 65 and is now eligible for Medicare. She Which of the following is NOT a correct statement
already receives Social Security benefits. How does about in-network provider services? -
she enroll in Original Medicare? - ANSWER - ANSWER -(INCORRECT) Network-based MA
Her enrollment in Medicare Parts A and B is plans have a provider network the member can use,
generally automatic if she meets all eligibility and some plans also cover certain services outside
requirements. the network.
Which statement is true about a member of a What is true about Medicare supplement open
Medicare Advantage (MA) Plan who wants to enroll enrollment? - ANSWER -(INCORRECT) A
in a Medicare Supplement Insurance Plan? - consumer who waits to enroll in Medicare Part B until
ANSWER -When a consumer enrolls in a age 66 or older cannot qualify for Medicare
Medicare Supplement Insurance Plan, they are not Supplement Open Enrollment.
automatically disenrolled from their MA Plan.
(INCORRECT) It is the only time a consumer is
eligible to purchase a Medicare Supplement
Being 65 or older, being under 65 years of age with Insurance Plan.
certain disabilities for more than 24 months, and
being any age with ESRD or ALS are each eligibility
requirements for which program? - ANSWER - Jennifer is enrolling into a Medicare Advantage (MA)
Original Medicare plan and wants to know what counts toward the Out-
of-Pocket Maximum. Which of the following is
accurate? - ANSWER -The Out-of-Pocket
Which of the following defines a Medicare Advantage Maximum will include her costs toward any Medicare-
(MA) Plan? (Select 2) - ANSWER -1. MA Plans covered Part A or B services.
must provide benefits equivalent to Original
Medicare, and most plans also offer additional
benefits. Which of the following statements is true about a
Medicare Supplement Insurance Plan member who
2. MA Plans provide Medicare hospital and medical wants to enroll in an MA Plan? - ANSWER -
insurance and often include Medicare prescription Medicare Supplement Insurance cannot be used in
drug coverage. conjunction with an MA Plan; therefore, after
receiving confirmation of enrollment into the MA Plan,
the member must cancel their Medicare Supplement
Which of the following is NOT an eligibility Insurance policy according to their carrier's rules.
requirement for enrollment in a Medicare Advantage
Plan? - ANSWER -Does not have any pre-
existing conditions such as diabetes or End Stage Which of the following best defines Medicare Part D?
Renal Disease (ESRD) - ANSWER -It is a government program, offered
only through a private insurance company or other
private company approved by Medicare, which
Which of the following statements is correct about provides prescription drug coverage.
HMO MA Plans? - ANSWER -Members must
receive covered services from contracted network
providers with limited exceptions. Which of the following is a fact about Medicare
Prescription Drug Plans? - ANSWER -To enroll,
member must be in plans service area
1/8
, UHC Certification 2 Latest Versions Exam Questions
and Answers
with physicians and pharmacists.
What are two options for Medicare consumers to get
Part D prescription drug coverage (assuming they Which of the following is true about Medicare
meet all eligibility requirements)? (Select 2) - Supplement Insurance underwriting criteria in states
ANSWER -Enroll in a stand-alone Medicare where underwriting applies? - ANSWER -
Prescription Drug Plan (PDP) Underwriting is required if the consumer is not in their
Medicare Supplement Open Enrollment period or
Enroll in a Medicare Advantage Plan or other does not meet Guaranteed Issue criteria.
Medicare health plan that includes prescription drug
coverage
The Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA), which went into effect January 1,
Which of the following statements does NOT 2020, applies to all carriers offering Medicare
correctly define prescription drug stages? - supplement plans. - ANSWER -True
ANSWER -A deductible is the amount the
member must pay for every prescription medication,
regardless of what stage they are in. Which of the following is NOT true of Medicare
Supplement Insurance Plans? - ANSWER -
(INCORRECT) Plan benefit amounts automatically
Which of these statements is NOT true about the update when Medicare changes cost sharing
drug utilization management (UM) rules? - amounts, such as deductibles, coinsurance and
ANSWER -(INCORRECT) Prior authorization, copayments.
quantity limit, and step therapy are some examples
of UM rules
Which of the following consumers are eligible for
Medicare if other eligibility requirements are met? -
What is the amount added to the member's monthly ANSWER -Consumers age 65 or older,
plan premium if they did NOT enroll in a Medicare consumers under 65 years of age with certain
Advantage plan with Part D benefits or stand-alone disabilities for more than 24 months and consumers
prescription drug plan when they were first eligible for of all ages with ESRD or ALS
Medicare Parts A and/or B or went without creditable
prescription drug coverage for 63 or more continuous
days? - ANSWER -Late Enrollment Penalty Which of the following defines a Medicare Advantage
(LEP) (MA) Plan? (Select 3) - ANSWER -An MA Plan
is a health plan option approved by Medicare and
offered by private insurance companies.
Can a consumer who qualifies for Low Income
Subsidy receive financial assistance for their part of An MA Plan provides Medicare hospital and medical
Medicare Part D costs? - ANSWER -Yes, insurance (Medicare Part A and Part B) and often
through subsidies such as lower or no monthly plan includes Medicare prescription drug coverage (Part
premiums and lower or no copayments D).
An MA Plan is part of Medicare and is also called
Formulary is defined as: - ANSWER -A list of Part C.
medications covered within the benefit plan, based
on CMS guidelines and developed in collaboration
Janice wants to enroll in a Medicare Advantage plan.
2/8
and Answers
Lisa turned 65 and is now eligible for Medicare. She Which of the following is NOT a correct statement
already receives Social Security benefits. How does about in-network provider services? -
she enroll in Original Medicare? - ANSWER - ANSWER -(INCORRECT) Network-based MA
Her enrollment in Medicare Parts A and B is plans have a provider network the member can use,
generally automatic if she meets all eligibility and some plans also cover certain services outside
requirements. the network.
Which statement is true about a member of a What is true about Medicare supplement open
Medicare Advantage (MA) Plan who wants to enroll enrollment? - ANSWER -(INCORRECT) A
in a Medicare Supplement Insurance Plan? - consumer who waits to enroll in Medicare Part B until
ANSWER -When a consumer enrolls in a age 66 or older cannot qualify for Medicare
Medicare Supplement Insurance Plan, they are not Supplement Open Enrollment.
automatically disenrolled from their MA Plan.
(INCORRECT) It is the only time a consumer is
eligible to purchase a Medicare Supplement
Being 65 or older, being under 65 years of age with Insurance Plan.
certain disabilities for more than 24 months, and
being any age with ESRD or ALS are each eligibility
requirements for which program? - ANSWER - Jennifer is enrolling into a Medicare Advantage (MA)
Original Medicare plan and wants to know what counts toward the Out-
of-Pocket Maximum. Which of the following is
accurate? - ANSWER -The Out-of-Pocket
Which of the following defines a Medicare Advantage Maximum will include her costs toward any Medicare-
(MA) Plan? (Select 2) - ANSWER -1. MA Plans covered Part A or B services.
must provide benefits equivalent to Original
Medicare, and most plans also offer additional
benefits. Which of the following statements is true about a
Medicare Supplement Insurance Plan member who
2. MA Plans provide Medicare hospital and medical wants to enroll in an MA Plan? - ANSWER -
insurance and often include Medicare prescription Medicare Supplement Insurance cannot be used in
drug coverage. conjunction with an MA Plan; therefore, after
receiving confirmation of enrollment into the MA Plan,
the member must cancel their Medicare Supplement
Which of the following is NOT an eligibility Insurance policy according to their carrier's rules.
requirement for enrollment in a Medicare Advantage
Plan? - ANSWER -Does not have any pre-
existing conditions such as diabetes or End Stage Which of the following best defines Medicare Part D?
Renal Disease (ESRD) - ANSWER -It is a government program, offered
only through a private insurance company or other
private company approved by Medicare, which
Which of the following statements is correct about provides prescription drug coverage.
HMO MA Plans? - ANSWER -Members must
receive covered services from contracted network
providers with limited exceptions. Which of the following is a fact about Medicare
Prescription Drug Plans? - ANSWER -To enroll,
member must be in plans service area
1/8
, UHC Certification 2 Latest Versions Exam Questions
and Answers
with physicians and pharmacists.
What are two options for Medicare consumers to get
Part D prescription drug coverage (assuming they Which of the following is true about Medicare
meet all eligibility requirements)? (Select 2) - Supplement Insurance underwriting criteria in states
ANSWER -Enroll in a stand-alone Medicare where underwriting applies? - ANSWER -
Prescription Drug Plan (PDP) Underwriting is required if the consumer is not in their
Medicare Supplement Open Enrollment period or
Enroll in a Medicare Advantage Plan or other does not meet Guaranteed Issue criteria.
Medicare health plan that includes prescription drug
coverage
The Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA), which went into effect January 1,
Which of the following statements does NOT 2020, applies to all carriers offering Medicare
correctly define prescription drug stages? - supplement plans. - ANSWER -True
ANSWER -A deductible is the amount the
member must pay for every prescription medication,
regardless of what stage they are in. Which of the following is NOT true of Medicare
Supplement Insurance Plans? - ANSWER -
(INCORRECT) Plan benefit amounts automatically
Which of these statements is NOT true about the update when Medicare changes cost sharing
drug utilization management (UM) rules? - amounts, such as deductibles, coinsurance and
ANSWER -(INCORRECT) Prior authorization, copayments.
quantity limit, and step therapy are some examples
of UM rules
Which of the following consumers are eligible for
Medicare if other eligibility requirements are met? -
What is the amount added to the member's monthly ANSWER -Consumers age 65 or older,
plan premium if they did NOT enroll in a Medicare consumers under 65 years of age with certain
Advantage plan with Part D benefits or stand-alone disabilities for more than 24 months and consumers
prescription drug plan when they were first eligible for of all ages with ESRD or ALS
Medicare Parts A and/or B or went without creditable
prescription drug coverage for 63 or more continuous
days? - ANSWER -Late Enrollment Penalty Which of the following defines a Medicare Advantage
(LEP) (MA) Plan? (Select 3) - ANSWER -An MA Plan
is a health plan option approved by Medicare and
offered by private insurance companies.
Can a consumer who qualifies for Low Income
Subsidy receive financial assistance for their part of An MA Plan provides Medicare hospital and medical
Medicare Part D costs? - ANSWER -Yes, insurance (Medicare Part A and Part B) and often
through subsidies such as lower or no monthly plan includes Medicare prescription drug coverage (Part
premiums and lower or no copayments D).
An MA Plan is part of Medicare and is also called
Formulary is defined as: - ANSWER -A list of Part C.
medications covered within the benefit plan, based
on CMS guidelines and developed in collaboration
Janice wants to enroll in a Medicare Advantage plan.
2/8
