Exam (elaborations)
UHC Certification Exam 2024/2025 Questions With Completed & Verified Solutions.
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UHC Certification Exam 2024/2025 Questions With Completed & Verified Solutions.
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UHCCertification
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?
-
ANS
Part
A
-
ANS
The
consumer
must
be
in
a
valid
MA
election
or
disenrollment
period.
Which
of
the
following
consumers
would
be
eligible
for
Medicare?
-
ANS
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?
-
ANS
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.)
-
ANS
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)
-
ANS
Which
of
the
following
are
MA
Plans
that
focus
on
using
network
providers
to
maximize
the
benefits
and
reduce
out-of-network
expenses?
-
ANS
HMO,
POS,
PPO
Which
is
true
about
Medicare
Supplement
Open
Enrollment?
-
ANS
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?
-
ANS
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?
-
ANS
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:
-
ANS
Medicare
Parts
A
and
B Which
of
the
following
statements
is
true
about
eligibility
requirements
for
Medicare
Prescription
Drug
Plans?
-
ANS
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)
-
ANS
Which
of
the
following
statements
is
not
true
about
the
Coverage
Gap?
-
ANS
All
members
reach
the
Coverage
Gap
Which
of
the
following
options
are
drug
utilization
management
(UM)
rules?
(Select
3)
-
ANS
Which
of
the
following
best
describes
the
Late
Enrollment
Penalty
(LEP)?
-
ANS
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
continuous
days
or
more.
Through
which
means
is
financial
assistance
offered
to
a
consumer
who
qualifies
for
Low
Income
Subsidy
for
their
part
of
Medicare
Part
D
costs?
-
ANS
Through
subsidies
such
as
lower
or
no
monthly
plan
premiums
and
lower
or
no
copayments
Medications
that
are
covered
in
a
Plan's
formulary
have
various
levels
of
associated
member
cost-sharing
(copayments
or
coinsurance).
What
are
these
drug
levels
called?
-
ANS
Drug
tiers
In
states
where
Medicare
Supplement
Insurance
underwriting
criteria
can
apply,
all
of
the
following
underwriting
criteria
apply
EXCEPT:
-
ANS
Consumers
may
be
underwritten
to
determine
their
acceptance
and,
if
applicable,
their
rate.
The
new
MACRA
legislation,
which
went
into
effect
January
1,
2020,
applies
to
all
carriers
offering
Medicare
supplement
plans.
-
ANS
TRUE
Which
of
the
following
is
NOT
true
of
Medicare
Supplement
Insurance
Plans?
-
ANS
Plan
benefit
amounts
automatically
update
when
Medicare
changes
cost
sharing
amounts,
such
as
deductibles,
coinsurance
and
copayments.
NOT
Which
definition
best
describes
Medicare
Part
A?
The
part
of
Medicare
that
is
a
voluntary
program
offered
by
private
insurance
companies
that
provides
prescription
drug
coverage
for
an
additional
monthly
premium.
The
part
of
Medicare
that
offers
combined
medical
and
prescription
drug
coverage.
The
part
of
Medicare
that
helps
with
the
cost
of
inpatient
hospital
stays.
It
also
helps
with
hospice
care
and
some
skilled
care
for
the
homebound.
The
part
of
Medicare
that
helps
with
the
cost
of
medically
necessary
doctor
visits
and
other
medical
services,
including
outpatient
care
at
hospitals
and
clinics,
laboratory
tests,
some
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