Download Medicare Certification Exam Questions and Answers: 2025-2026 and more Exams Medical ethics in PDF only on Docsity!
2025 - 2026 UHC CERTIFICATIONS EXAM|ORIGINAL
EXAM|100%VERIFIED|A+GRADE
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? - ANS:->>> Her enrollment in Medicare Parts A and B is generally automatic ifshe meets all eligibility requirements. Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? **- ANS:-
** When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan. Being 65 or older, being under 65 years of age with certain disabilities formore than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? - ANS:->>> Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) - ANS:->>> 1. MA Plans must provide benefits equivalent to Original Medicare, and most plans also offer additional benefits.
- MA Plans provide Medicare hospital and medical insurance and ofteninclude Medicare prescription drug coverage. Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? - ANS:->>> Does not have any pre- existing conditions such as diabetes or End Stage Renal Disease (ESRD) Which of the following statements is correct about HMO MA Plans? - **ANS:-
** Members must receive covered services from contracted network providers with limited exceptions. Which of the following is NOT a correct statement about in-network provider services? - ANS:->>> (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. What is true about Medicare supplement open enrollment? ANS:->>> ✅ (INCORRECT) A consumer who waits to enroll in Medicare Part B until age
coverage. Which of the following is a fact about Medicare Prescription Drug Plans? - **ANS:-
** To enroll, member must be in plans service area What are two options for Medicare clients to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) - **ANS:- ** Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan thatincludes prescription drug coverage. Which of the following statements does NOT correctly define prescription drug stages? - ANS:->>> A deductible is the amount the member must pay for every prescription medication, regardless of what stage theyare in. Which of these statements is NOT true about the drug utilization management (UM) rules? - ANS:->>> (INCORRECT) Prior authorization, quantity limit, and step therapy are some examples of UMrules What is 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 PartsA and/or B or went without creditable prescription drug coverage for 63 or more continuous days? - ANS:->>> Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? - ANS:->>> Yes, through subsidies such as lower or no monthly plan premiums and lower orno copayments Formulary is defined as: - ANS:->>> A list of medications coveredwithin the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? ANS:->>> ✅Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issuecriteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which
Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? - ANS:->>>Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) Which of the following are MA Plans that focus on using network providersto maximize the benefits and reduce out-of-network expenses? - ANS:->>>HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolledher into a stand-alone PDP? - ANS:->>>She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? - ANS:->>>A voluntary program, offered by private insurance companies that are contracted with the federal
government, that provides prescription drug coverage for an additionalmonthly plan premium Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? - ANS:->>>A consumer must be entitled to Medicare Part A and/or enrolled in MedicarePart B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer getPart D prescription drug coverage? - ANS:->>>They could enroll in astand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? - ANS:-
Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7 - day limit, DispensingLimit and Limited Access are all examples of what? ANS:->>> ✅Utilization Management Rules
Reauthorization Act of 2015 (MACRA) impact to Plans C and F? - ANS:-
Clients already enrolled in Plans C or F are required to changeplans.
Which statement is true about medicare supplements? ANS:->>> ✅Insured members have the freedom to choose any doctor who acceptsMedicare patients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effective on July 1. Using her Initial Election Period (IEP), when can she submit an application for a Medicare Advantage or Prescription Drug plan? - ANS:-
April 1 through October 31 Annual Election Period (AEP) is a time when... ANS:->>> ✅Clients can elect to switch to a different plan or join a MedicareAdvantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan hehas been presenting. Which statement is correct? - ANS:->>>Mrs. Violet can access the Star Rating for a plan on Medicare.gov or in the
In which of the following situations can telephonic contact be made with a Medicare eligible consumer? - ANS:->>>When the consumer consented to be contacted for sales activities and the permission has not yetexpired. Which statement is true about discussing benefits with the consumer beforean enrollment? - ANS:->>>The agent must accurately and completely disclose any benefits discussed. When completing an enrollment application in LEAN, why is an agent prohibited from entering his or her own email address in a field available forthe consumer's email address? - ANS:->>>The consumer/member would not receive plan related correspondence intended for him/her. The ensures that when clients provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, aswell as the standard disclosures. - ANS:->>>Statement of Understanding
What is Scope of Appointment? - ANS:->>>The agreement obtainedfrom the consumer to that identifies the scope of products that can be discussed at a personal/individual marketing appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albertseems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? - ANS:->>>Jane should ask Albert if someone, such as an Authorized Legal Representative,helps him make health care or insurance-related decisions and should be present. Melanie is currently enrolled in a Medicare Supplement Insurance Plan and a PDP. Assuming she has a valid election period, what would happen if she enrolled in an HMO MAPD plan? - ANS:->>>(INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. Medicare Advantage (MA) organization must disenroll a member from anMA plan in which situation? - ANS:->>>The member loses entitlement to either Medicare Part A or Part B.
AARP expects agents offering AARP-branded products to demonstrate fivekey behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is. - ANS:-
Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) - ANS:->>>Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do clients have to be an AARP member to enroll in an AARP-brandedplan with UnitedHealthcare? - ANS:->>>Yes, if the consumer is enrolling in a Medicare
Supplement Plan. How many status levels are in the Authorized to Offer Program? - ANS:->>> 2
the members? (Select 3) - ANS:->>>
Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3) - ANS:->>>MA, PDP, Supplements Dual Special Needs Plans (D-SNP) are defined as which of the following: - ANS:-
Medicare Advantage Plans uniquely designed for clients enrolled in both Medicare and Medicaid. When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility? - ANS:->>>Uponnotification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a D-SNP? - ANS:- Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) Which statement best describes a care management program that variesdepending upon the level of the member's health risk? ANS:->>> ✅Support provided to C-SNP and D-SNP members that may have uniquehealth care needs
