2024 UHC CERTIFICATION 94 QUESTIONS WITH COMPLETE SOLUTIONS, Exams of Nursing

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2024 UHC CERTIFICATION 94 QUESTIONS

WITH COMPLETE SOLUTIONS

Lisa turned 65 and is now eligible for Medicare. She already receives SocialSecuritybenefits.HowdoessheenrollinOriginalMedicare?CorrectAnswer:Herenrollment in Medicare Parts A and B is generally automatic if she meets alleligibilityrequirements. WhichstatementistrueaboutamemberofaMedicareAdvantage(MA)PlanwhowantstoenrollinaMedi careSupplementInsurancePlan?CorrectAnswer:Whena consumer enrolls in a Medicare Supplement Insurance Plan, they are notautomaticallydisenrolledfrom theirMAPlan. Being65orolder,beingunder65yearsofagewithcertaindisabilitiesformorethan 24 months, and being any age with ESRD or ALS are each eligibilityrequirementsforwhich program? CorrectAnswer:OriginalMedicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)Correct Answer:1. MA Plans must provide benefits equivalent to OriginalMedicare,andmost plansalsoofferadditional benefits.

2. MA Plans provide Medicare hospital and medical insurance and often includeMedicareprescription drug coverage. WhichofthefollowingisNOTaneligibilityrequirementforenrollmentinaMedicare Advantage Plan? Correct Answer:Does not have any pre- existingconditionssuchasdiabetesorEndStageRenalDisease(ESRD) Which of the following statements is correct about HMO MA Plans? CorrectAnswer:Members must receive covered services from contracted networkproviderswith limitedexceptions. Which of the following is NOT a correct statement about in-network providerservices? Correct

Answer:(INCORRECT) Network-based MA plans have aprovidernetworkthemembercanuse,andsomeplansalsocovercertainservicesoutside the network. What is true about Medicare supplement open enrollment? Correct Answer: (INCORRECT)Aconsumerwho waits to enrollin Medicare Part B untilage oroldercannotqualify forMedicare SupplementOpenEnrollment. (INCORRECT)ItistheonlytimeaconsumeriseligibletopurchaseaMedicareSupplementInsurancePl an. Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to knowwhat counts toward the Out-of-Pocket Maximum. Which of the following isaccurate? CorrectAnswer:TheOut-of-PocketMaximumwillincludehercoststowardanyMedicare-covered PartAor Bservices. WhichofthefollowingstatementsistrueaboutaMedicareSupplementInsurancePlan member who wants to enroll in an MA Plan? Correct Answer:MedicareSupplement Insurance cannot be used in conjunction with an MA Plan; therefore,after receiving confirmation of enrollment into the MA Plan, the member mustcancel their Medicare Supplement Insurance policy according to their carrier'srules. Which of the following best defines Medicare Part D? Correct Answer:It is agovernmentprogram,offeredonlythroughaprivateinsurancecompanyorotherprivate company approved by Medicare, which provides prescription drugcoverage. WhichofthefollowingisafactaboutMedicarePrescriptionDrugPlans?CorrectAnswer:Toenroll, membermustbeinplansservice area What are two options for Medicare consumers to get Part D prescription drugcoverage (assuming they meet all eligibility requirements)? (Select 2) CorrectAnswer:Enrollinastand-aloneMedicare PrescriptionDrugPlan(PDP) Enroll in a Medicare Advantage Plan or other Medicare health plan that

Which of these statements is NOT true about the drug utilization management(UM)rules? CorrectAnswer: (INCORRECT)Priorauthorization,quantitylimit,andsteptherapyaresomeexamplesof UMrules What is the amount added to the member's monthly plan premium if they did NOTenroll in a Medicare Advantage plan with Part D benefits or stand-aloneprescription drug plan when they were first eligible for Medicare Parts A and/or Bor went without creditable prescription drug coverage for 63 or more continuousdays?CorrectAnswer:LateEnrollmentPenalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financialassistance for their part of Medicare Part D costs? Correct Answer: Yes, throughsubsidiessuchaslowerornomonthlyplanpremiumsandlowerornocopayments Formulary is definedas:CorrectAnswer:Alistof medicationscoveredwithin thebenefit plan, based on CMS guidelines and developed in collaboration withphysiciansandpharmacists. WhichofthefollowingistrueaboutMedicareSupplementInsuranceunderwritingcriteria in states where underwriting applies? Correct Answer:Underwriting isrequired if the consumer is not in their Medicare Supplement Open Enrollmentperiodor doesnot meetGuaranteedIssue criteria. TheMedicareAccessand CHIPReauthorizationActof2015(MACRA),whichwent into effect January 1, 2020, applies to all carriers offering Medicaresupplementplans. CorrectAnswer:True Which of the following is NOT true of Medicare Supplement Insurance Plans?Correct Answer: (INCORRECT) Plan benefit amounts automatically update whenMedicare changes cost sharing amounts, such as deductibles, coinsurance andcopayments. Which of the following consumers are eligible for Medicare if other eligibilityrequirementsaremet?CorrectAnswer:Consumersage65orolder,consumersunder 65 years of age with certain disabilities for more than 24 months andconsumersof all ages withESRDorALS

Which of the following defines a Medicare Advantage (MA) Plan? (Select 3)Correct Answer: An MA Plan is a health plan option approved by Medicare andofferedby privateinsurancecompanies.

Access are all examples of what? Correct Answer:UtilizationManagementRules Aconsumermayhavetopay aLateEnrollmentPenalty(LEP)iftheydidNOTenrollinaMedicareAdvantageplanwithPartDbenefits or stand-alone

prescription drugplanwhen theywerefirsteligibleforMedicarePartsAand/or Borwentwithoutcreditableprescriptiondrugcoveragefor. CorrectAnswer:63ormorecontinuousdays Through which means is financial assistance offered to a consumer who qualifiesforLowIncomeSubsidyfortheirpartofMedicarePartDcosts?CorrectAnswer:Through subsidies such as lower or no monthly plan premiums and lower or nocopayments Which of the following lists drug tiers from least expensive cost share to mostexpensive cost share? Correct Answer:Preferred Generics, Generics, PreferredBrand(andsomehigher- costgenerics),Non-PreferredDrug(andsomehigher-costgenerics),Specialty Which of the following is NOT true about the Medicare Access and CHIPReauthorizationActof2015(MACRA)impact toPlansCandF? CorrectAnswer:ConsumersalreadyenrolledinPlansCorFarerequired tochangeplans. Which statement is true about medicare supplements? Correct Answer:InsuredmembershavethefreedomtochooseanydoctorwhoacceptsMedicarepatients. Cynthia is turning 65 on July 5. Her Medicare Part A and Part B will be effectiveon July 1. Using her Initial Election Period (IEP), when can she submit anapplicationforaMedicareAdvantageorPrescriptionDrugplan?CorrectAnswer:April1 through October 31 Annual Election Period (AEP) is a time when... Correct Answer:Consumers canelect to switch to a different plan or join a Medicare Advantage plan or PrescriptionDrugPlan. Mrs.VioletasksagentBobwhereshecanfindtheStarRatingfortheplanhehasbeen presenting. Which statement is correct? Correct Answer:Mrs. Violet canaccesstheStarRatingforaplanonMedicare.govorintheEnrollmentGuide. In which of the following situations can telephonic contact be made with

Which statement is true about discussing benefits with the consumer before anenrollment? Correct Answer:The agent must accurately and completely discloseanybenefits discussed. WhencompletinganenrollmentapplicationinLEAN,whyisanagentprohibitedfrom entering his or her own email address in a field available for the consumer'semail address? Correct Answer:The consumer/member would not receive planrelatedcorrespondenceintendedfor him/her. The ensures that when consumers provide their verbal agreementduring the telephonic enrollment, they acknowledge and understand they areactually enrolling, in which plan they are enrolling, as well as the standarddisclosures. CorrectAnswer:Statementof Understanding WhatisScopeofAppointment?CorrectAnswer:Theagreement obtainedfromtheconsumer to that identifies the scope of products that can be discussed at apersonal/individualmarketing appointment Jane, an agent, is speaking to Albert about a Prescription Drug plan. Albert seemsconfusedandisstrugglingtounderstandtheinformationJaneisexplaining.Whichoption should Jane consider? Correct Answer:Jane should ask Albert if someone,such as an Authorized Legal Representative, helps him make health care orinsurance-relateddecisionsandshouldbe present. MelanieiscurrentlyenrolledinaMedicareSupplementInsurancePlanandaPDP.Assuming she has a valid election period, what would happen if she enrolled in anHMO MAPD plan? Correct Answer: (INCORRECT) She would be automaticallydisenrolledfromtheMedicareSupplementInsurancePlanandthePDP. MedicareAdvantage(MA)organizationmustdisenroll a member fromanMAplanin which situation? Correct Answer:The member loses entitlement to eitherMedicarePartAor Part B. Aries is currently a member of a stand-alone PDP. Aries would like to haveadditional medical coverage. A thorough needs analysis indicates a MedicareAdvantagePlanwouldbeagoodfit,thereareplansavailableinhisarea, andheisin a valid

election period. Which option is available to Aries? Correct Answer:Aries can enroll into a Medicare Advantage plan with prescription drug coverage,whichwilldisenroll himfrom hisPDP.

Which of the followingstatementsaboutAARPareTRUE? (Select2)CorrectAnswer:TheAARPmotto istoserve, not be served.

AARPadvocatesforthe50+populationincongressforlegislationtolowermedicalcosts. Which of the following is TRUE about the production requirement for theAuthorizedto OfferElitestatus?CorrectAnswer:Eachcalendaryear,agentsneedto have at least 30 commission- eligible, accepted, and paid AARP MedicareSupplement Plan and/or Medicare Select Plan sales or retain a book of business of150or moreactive members. ThevaluepropositionfortheAARPbrand isseen inwhatkindsofbenefitsforthemembers? (Select 3) CorrectAnswer: Which AARP-branded Medicare products does UnitedHealthcare offer? (Select 3)CorrectAnswer:MA,PDP, Supplements DualSpecialNeedsPlans(D-SNP)aredefinedaswhichofthefollowing:CorrectAnswer:Medicare Advantage Plans uniquely designed for consumers enrolled inbothMedicareandMedicaid. WhendoestheSpecial ElectionPeriodforDual/LISChangeinStatusbeginforD-SNP members that lose Medicaid eligibility? Correct Answer:Upon notificationoreffective dateofthe loss,whicheverisearlier Which consumermightbenefitthemostbyenrollinginaD-SNP?CorrectAnswer:Joe, whoreceivesQualifiedMedicaid Beneficiarybenefits(QMB+) Whichstatementbest describesacaremanagementprogramthatvariesdependingupon the level of the member's health risk? Correct Answer:Support provided toC-SNPandD-SNPmembers thatmayhaveunique healthcareneeds Selectthestatementthatbest describesafeatureofD-SNPs.CorrectAnswer:D-SNPsarenetwork- based When selling D-SNPs, agents must: Correct Answer:Confirm the consumer'sMedicaid level and that theconsumerisentitledtoMedicarePartAandenrolledinPartB

The following is a characteristic of consumers for whom a C-SNP may be mostappropriate:CorrectAnswer:Consumerswhohaveaqualifyingchroniccondition,are focused on their health issues and may have concerns with having to managetheirillness or dealingwith multipleproviders On July 19, each of the following consumers met with an agent. Based on theinformation provided, which consumer must wait until the Annual Election Period(AEP) or Open Enrollment Period (OEP) to enroll? Correct Answer:Joy has acardiovasculardisorder,isenrolledinaC- SNPthatcoversthecondition,andwantstoenrollinanotherCSNPofferedbytheplanthatcoversthesame condition. WhichservicewillaC-SNPorD-SNPmemberinthehighriskcaremanagementcategory receive? Correct Answer: Case Management (telephonic, digital and/orface-to-face)according to individual needs Which statement is true about provider information on the Chronic ConditionVerificationForm? CorrectAnswer:Theproviderindicatedontheformdoesnothave to be contractedwith the plan. Which statement is true about the Medicaid program? Correct Answer: Benefitsvaryfrom stateto state. Which statement is true of D-SNP members? Correct Answer:Members who areQMB+orareFullDual-EligiblearenotrequiredtopaycopaymentsforMedicare-covered services obtained from a D-SNP in-network provider. Their providershould billthe stateMedicaidprogram,asappropriate,forthesecosts. How long do plans using the C-SNP pre-enrollment verification process have toverify the qualifying chronic condition until they must deny the enrollmentrequest? CorrectAnswer:Within21daysoftherequestforadditionalinformationor the end of the month in which the enrollment request is made (whichever islonger). Lucille is no longer eligible for her state Medicaid program and has lost hereligibility for the D-

SNP in which she is enrolled. What is her responsibility forcostsharing? CorrectAnswer:All,suchaspremiums,deductibles, copayments,andcoinsurance

Which of the following food and beverage options may be provided at aneducational eventifthenominalretailvalueoftheitemswhen combinedwith

othergiveawaysdoesnotexceed$15perperson?(Select2)CorrectAnswer:Coffee, juice,freshfruit,andpastries Boxedlunchwithassortednon-alcoholicbeverages Ifyouconductaneducationalevent andinvite aproviderorvendortobea partofthe event, the provider/vendor must not do which of the following? CorrectAnswer:Provide free health screenings such as blood pressure checks or hearingtestsas amarketing activity Agent John Rogers is planning a formal marketing/sales event and has decided toplace an advertisement in the local paper. What disclaimers must John include inthe advertisement? Correct Answer:"For accommodation of persons with specialneedsat salesmeetings, call 555- 555-1234,TTY711." Janine is conducting a marketing/sales event in a senior center cafeteria. Thecafeteriagenerallyprovidesadinnermealfrom5pmto6pm.CanJanineconducther marketing/sales meeting in the cafeteria between 5pm and 6pm? CorrectAnswer:No, she can conduct an event that ends no later than 5pm or wait untilafter6pm. Agent Rita Garcia must not do which of the following while conducting amarketing/salesevent? CorrectAnswer:Statetheplansheispresentingisthebestplanon the market. At a formal marketing/sales event, an agent presented information aboutprescriptiondrugcoverage.Whichstatementisnotaccurate?CorrectAnswer:Members and providers are not able to ask the plan for exceptions to anyutilizationmanagementrules Ataninformal marketing/salesevent,whichofthefollowingactivitiesisnotpermitted? Correct Answer:Approaching consumers as they pass by yourbooth/kiosk/table Agent Santana has developed a relationship with Dr. Westberry, a Primary CareProvidercontractedwithseveralMedicareAdvantagePlans.Dr.Westberryisaskedtoattendaform al marketing/salesevent conductedbyAgentSantana.Whichof Dr. Westberry's actions is non-