UHC CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024-2025
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIF
ANSWERS)
Study online at https://quizlet.com/_fpmiye
Medicare Federal health insurance program
CMS ( Centers for medicare and medic-
Medicare is administered by whom?
aid services)
federal health insurance program re-
Parts A & B of medicare are
ferred to as original medicare
Part A? Hospital insurance
Part B? Medical insurance
routine dental, eye care hearing
What doesnt medicare cover? exam,deductibles, coinsurance and co-
payments
Part C? Medicare Advantage Plans
Part A &B coverage, and some part D
MA covers?
coverage
MA plans are not? Medicare supplement insurance plans
What offers lower monthly premiums
MADP
MADP or supplement?
do MAP's have a annual maximum OOP
maximum that limits the amount of mon-
YES
ey a member must spend every year for
covered services?
MA plans integrate what type of additon-
part D prescription drug coverage
al coverage?
If a customer wants to keep their stand
alone prescription drug plan, what may MA-only PFFS plan
the customer want to enroll in?
What is a stand alone drug plan called? PDP
Private Fee for Service (PFFS) - Plans
WHat is PFFS? that allow you to go to any doctor or
hospital that accepts their terms
If a customer lives in a rural area, what
PFFS plan
type of plan may they want because it
, UHC CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024-2025
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIF
ANSWERS)
Study online at https://quizlet.com/_fpmiye
gives them freedom to access doctors
that may not be in their network?
Do HMO's require referals? Yes
Do PPO's require a referal? No
When a member enrolls in a MA
plan, they receive their coverage from MA plan
medicare or the MA plan?
When a customer is enrolled in a MA
plan, they must continue paying their Part B
premiums for what other plan?
MA plans have a maxium annual limit on
MOOP amount ( Maxium out of pocket)
OOP costs called a?
When a member is enrolled in a MA plan,
they are automatically disenrolled from
any other MA plan or PDP( prescription effective date
drug plan) in which they are enrolled as
of the new plans_____?
An exception exisits for MA-only PFFS
plans as a member can also be enrolled Stand alone PDP
in a what?
Cancel in writing their medicare supple-
If a member enrolls in a MA plan, what ment insurance policy with the carrier af-
must the member do? ter their request to enroll in MA plan has
been approved.
Medicare supplement insurance policies
cannot be used in conjunction with what MA plan
type of plan?
A medicare supplement insurance plan
helps to cover some of the OOP costs original medicare.
associated with?
A medicare supplement insurance plan
does NOT pay the cost-sharing of what MA plan
type of plan?
, UHC CERTIFICATION EXAM AND PRACTICE EXAM NEWEST 2024-2025
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIF
ANSWERS)
Study online at https://quizlet.com/_fpmiye
when a client enrolls in a MA plan, will it
NO
automatically terminate their MA plan?
Can a customer call to terminate their
no it must be done in writing
Med Sup plan?
What are the different types of MA HMO, POS, PPO, RPPO, PFFS, SNP,
plans? and MSA
For an HMO, they customer must us IN
Emergencies, Urgent care, and renal
network providers, what are the excep-
dialysis services.
tions to their rule?
In a HMO plan, does a member have
to choose a PCP? and do they require Yes
referrals to see a specialist?
In a POS plan, does a member need a
referral from their PCP to see a special- yes
ist?
Can a member with a POS plan see a Yes, but they may have to pay a higher
specialist? cost, and there coverage limits
With a PFFS plan, can a member seek
treatment from any medicare eligible
Yes
provider who agrees to accept the plans
conditions and payment rates?
Does a PCP need to be selected with a
No
PFFS plan?
What is the only plan to offer non-net-
UHC
work PFFS plans?
People who have both medicare and
What are SNP's for? ( Dual SNP)
Medicaid
Institutional SNP? Nursing homes
people who have certain chronic medical
Chronic condition SNP?
conditions
MSA? Medical savings account
What does a MSA do?
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