UHC Certification questions and answers
2025\2026 A+ Grade
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
2025\2026 A+ Grade
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
