UHC CERTIFICATION ACTUAL
EXAM 2024-2025 LATEST UPDATED
100 ACTUAL QUESTIONS WITH
VERIFIED CORRECT ANSWERS. A+
GRADE RATED
1. Lisa turned 65 and is now eligible for Medicare. She already
receives Social Security benefits. How does she enroll in Original
Medicare?: Her enrollment in Medicare Parts A and B is generally
automatic if she meets all eligibility requirements.
2. Which statement is true about a member of a Medicare Advantage
(MA) Plan who wants to enroll in a Medicare Supplement Insurance
Plan?: When a consumer enrolls in a Medicare Supplement Insurance Plan,
they are not automatically disenrolled from their MA Plan.
3. Being 65 or older, being under 65 years of age with certain
disabilities for more than 24 months, and being any age with ESRD or
ALS are each eligibility requirements for which program?: Original
Medicare
4. Which of the following defines a Medicare Advantage (MA) Plan?
(Select 2): 1. MA Plans must provide benefits equivalent to Original
Medicare, and most plans also offer additional benefits.
,2. MA Plans provide Medicare hospital and medical insurance and often
include Medicare prescription drug coverage.
5. Which of the following is NOT an eligibility requirement for
enrollment in a Medicare Advantage Plan?: Does not have any pre-
existing conditions such as diabetes or End Stage Renal Disease (ESRD)
6. Which of the following statements is correct about HMO MA
Plans?: Members must receive covered services from contracted network
providers with limited exceptions.
7. Which of the following is NOT a correct statement about in-
network provider services?: (INCORRECT) Network-based MA plans
have a provider network the member can use, and some plans also cover
certain services outside the network. 8. What is true about Medicare
supplement open enrollment?: (INCORRECT) A consumer who waits to
enroll in Medicare Part B until age 66 or older cannot qualify for Medicare
Supplement Open Enrollment.
(INCORRECT) It is the only time a consumer is eligible to purchase a
Medicare Supplement Insurance Plan.
9. Jennifer is enrolling into a Medicare Advantage (MA) plan and
wants to know what counts toward the Out-of-Pocket Maximum.
Which of the following is accurate?: The Out-of-Pocket Maximum will
include her costs toward any Medicare-covered Part A or B services.
10. Which of the following statements is true about a Medicare
Supplement Insurance Plan member who wants to enroll in an MA
Plan?: Medicare Supplement Insurance cannot be used in conjunction
with an MA Plan; therefore, after receiving confirmation of enrollment
, into the MA Plan, the member must cancel their Medicare Supplement
Insurance policy according to their carrier's rules.
11. Which of the following best defines Medicare Part D?: It is a
government program, offered only through a private insurance company
or other private company approved by Medicare, which provides
prescription drug coverage.
12. Which of the following is a fact about Medicare Prescription Drug
Plans?-
: To enroll, member must be in plans service area
13. What are two options for Medicare consumers to get Part D
prescription drug coverage (assuming they meet all eligibility
requirements)? (Select 2): Enroll in a stand-alone Medicare Prescription
Drug Plan (PDP)
Enroll in a Medicare Advantage Plan or other Medicare health plan that
includes prescription drug coverage
14. Which of the following statements does NOT correctly define
prescription drug stages?: A deductible is the amount the member must
pay for every prescription medication, regardless of what stage they are
in.
15. Which of these statements is NOT true about the drug utilization
management (UM) rules?: (INCORRECT) Prior authorization, quantity
limit, and step therapy are some examples of UM rules
16. 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
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