2023 UHC certifications ALL SOLUTION 100% CORRECT GUARANTEED GRADE A+

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. 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. 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 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. 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) Which of the following statements is correct about HMO MA Plans? 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? (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? (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. 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. 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. 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. Which of the following is a fact about Medicare Prescription Drug Plans? To enroll, member must be in plans service area 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 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. 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 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? Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: A list of medications covered within 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? Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. True Which of the following is NOT true of Medicare Supplement Insurance Plans? (INCORRECT) Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. Which of the following consumers are eligible for Medicare if other eligibility requirements are met? 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? (Select 3) 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). An MA Plan is part of Medicare and is also called Part C. Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? 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 providers to maximize the benefits and reduce out-of-network expenses? HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? A 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 statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? Utilization Management Rules A consumer may have to pay a Late Enrollment Penalty (LEP) 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 Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? Through subsidies such as lower 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? Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? Consumers already enrolled in Plans C or F are required to change plans. Which statement is true about medicare supplements? Insured members have the freedom to choose any doctor who accepts Medicare 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? April 1 through October 31 Annual Election Period (AEP) is a time when. . . Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Mrs. Violet asks agent Bob where she can find the Star Rating for the plan he has been presenting. Which statement is correct? Mrs. Violet can access the Star Rating for a plan on M or in the Enrollment Guide. In which of the following situations can telephonic contact be made with a Medicare eligible consumer? When the consumer consented to be contacted for sales activities and the permission has not yet expired. Which statement is true about discussing benefits with the consumer before an enrollment? 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 for the consumer's email address? The consumer/member would not receive plan related correspondence intended for him/her. The __________ ensures that when consumers provide their verbal agreement during the telephonic enrollment, they acknowledge and understand they are actually enrolling, in which plan they are enrolling, as well as the standard disclosures. Statement of Understanding What is Scope of Appointment? The agreement obtained from 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. Albert seems confused and is struggling to understand the information Jane is explaining. Which option should Jane consider? 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? (INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. CONTINUED...