UHC 2024 AHIP - Medicare Basics
Assessment (Medicare Advantage
[non-SNP], Prescription Drug and
Medicare Supplement Plans)
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits.
How does she enroll in Original Medicare? - ANSHer enrollment in Medicare Parts A and B is
generally automatic if she 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? - ANSWhen 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 a qualifying disability or being any age with
ESRD or ALS are each eligibility requirements for which program? - ANSOriginal Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - ANS-An MA Plan
is part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private insurance
companies.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B)
and often includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be entitled to
Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is
being described? - ANSMedicare Advantage
Which of the following is a correct statement about in-network provider services? - ANSHMO
Plans cover only in-network services. In most cases, members pay the full cost of any
out-of-network services received, with a few important exceptions.
Which of the following is NOT a correct statement about in-network provider services? -
ANSHMO-POS Plans only cover in-network services.
Which statement is true about Medicare Supplement Open Enrollment? - ANSIt is the six-month
period that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.
, Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum? - ANSAll
MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for
Medicare-covered medical services.
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a
stand-alone PDP? - ANSShe would be disenrolled automatically from her MAPD Plan.
What is Medicare Part D? - ANSA voluntary program, offered by private insurance companies
that are contracted with the federal government, that provides prescription drug coverage for an
additional monthly plan premium.
Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug
Plan? - ANSEntitled to Part A and/or enrolled in Part B and reside in the plan service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible
consumer get Part D prescription drug coverage? - ANSThey could enroll in a Medicare
Advantage Plan or other Medicare health plan that includes prescription drug coverage.
Which of the following statements accurately describes a prescription drug stage? - ANSStarting
in 2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs
for the remainder of the plan year.
Which of these statements is NOT true about the drug utilization management (UM) rules? -
ANSIf a medication has a UM rule, the member will not be able to get that medication.
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 Parts A and/or B or went without creditable prescription drug
coverage for 63 or more continuous days? - ANSLate Enrollment Penalty (LEP)
What kind of financial assistance does a consumer receive who qualifies for Low Income
Subsidy? - ANSLower or no monthly plan premiums and lower or no copayments
Which of the following lists drug tiers from least expensive cost share to most expensive cost
share? - ANSPreferred Generics, Generics, Preferred Brand (and some higher-cost generics),
Non-Preferred Drug (and some higher-cost generics), Specialty
In states where Medicare Supplement Insurance underwriting criteria can apply, all of the
following underwriting criteria apply EXCEPT: - ANSMost consumers who are switching from
another Medicare supplement plan are entitled to Guaranteed Issue and, therefore, are not
subject to underwriting.
Which of the following are true about the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) Plans and the impact to Plans C and F? (Select 2) - ANS-Consumers eligible for
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