Understanding Medicare Advantage Plans and Medicare Supplement Insurance, Exams of Nursing

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2024 UHC CERTIFICATIONS 94 QUESTIONS WITH

COMPLETE SOLUTIONS

Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct Answer: 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? Correct Answer: 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? Correct Answer: Original Medicare Which of the following defines a Medicare Advantage (MA) Plan? (Select 2) Correct Answer: 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? Correct Answer: 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? Correct Answer: 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? Correct Answer: (INCORRECT) Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network.

Which of these statements is NOT true about the drug utilization management (UM) rules? Correct Answer: (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? Correct Answer: Late Enrollment Penalty (LEP) Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Correct Answer: Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments Formulary is defined as: Correct Answer: 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? Correct Answer: 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. Correct Answer: True Which of the following is NOT true of Medicare Supplement Insurance Plans? Correct Answer: (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? Correct Answer: 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) Correct Answer: 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? Correct Answer: 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? Correct Answer: HMO, POS, PPO Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? Correct Answer: She would be disenrolled automatically from her MAPD Plan. What is Medicare Part D? Correct Answer: 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? Correct Answer: 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? Correct Answer: They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). In what order do the four prescription drug coverage stages occur? Correct Answer: 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? Correct Answer: 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

Which statement is true about discussing benefits with the consumer before an enrollment? Correct Answer: 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? Correct Answer: 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. Correct Answer: Statement of Understanding What is Scope of Appointment? Correct Answer: 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? Correct Answer: 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? Correct Answer: (INCORRECT) She would be automatically disenrolled from the Medicare Supplement Insurance Plan and the PDP. Medicare Advantage (MA) organization must disenroll a member from an MA plan in which situation? Correct Answer: The member loses entitlement to either Medicare Part A or Part B. Aries is currently a member of a stand-alone PDP. Aries would like to have additional medical coverage. A thorough needs analysis indicates a Medicare Advantage Plan would be a good fit, there are plans available in his area, and he is in a valid election period. Which option is available to Aries? Correct Answer: Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP.

In what product should agents enroll consumers? Correct Answer: A product that is suitable for the consumer's needs, goals and financial resources. Dino, an agent, received a phone call on September 29 from a consumer interested in Medicare Advantage plans for the new plan year. Dino proceeded to verify the consumer's Medicare eligibility, describe the costs and benefit coverage of the plan, and explained that he could not accept an enrollment application until October 15. What did Dino do that was NOT compliant? Correct Answer: Presented a plan before October 1 Which of the following is NOT true about UnitedHealthcare Medicare plans carrying the AARP name? Correct Answer: AARP endorses UnitedHealthcare MA, PDP and Medicare Supplement plans. AARP expects agents offering AARP-branded products to demonstrate five key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is. Correct Answer: Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? (Select 3) Correct Answer: Being upfront about what information means. Communicating clearly to alleviate any confusion. Providing the right information. Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare? Correct Answer: Yes, if the consumer is enrolling in a Medicare Supplement Plan. How many status levels are in the Authorized to Offer Program? Correct Answer: 2 According to AARP, there are how many individual AARP members? Correct Answer: Nearly 37 million Which of the following statements about AARP are TRUE? (Select 2) Correct Answer: The AARP motto is to serve, not be served.

The following is a characteristic of consumers for whom a C-SNP may be most appropriate: Correct Answer: Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? Correct Answer: Joy has a cardiovascular disorder, is enrolled in a C-SNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition. Which service will a C-SNP or D-SNP member in the high risk care management category receive? Correct Answer: Case Management (telephonic, digital and/or face-to-face) according to individual needs Which statement is true about provider information on the Chronic Condition Verification Form? Correct Answer: The provider indicated on the form does not have to be contracted with the plan. Which statement is true about the Medicaid program? Correct Answer: Benefits vary from state to state. Which statement is true of D-SNP members? Correct Answer: Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare- covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs. How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? Correct Answer: Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the D-SNP in which she is enrolled. What is her responsibility for cost sharing? Correct Answer: All, such as premiums, deductibles, copayments, and coinsurance

What type of event must an agent conduct when they want to be able to collect consumer information, schedule future appointments, and accept enrollment applications? Correct Answer: Marketing/sales event Which of the following does not describe a personal/individual marketing appointment? Correct Answer: It needs to be reported to UnitedHealthcare prior to advertising and not less than 7 calendar days prior to the date of the event When conducting an event, agents should select a site that is compliant with the Americans with Disabilities Act (ADA). Which of the following is not an ADA requirement? Correct Answer: Extra-wide sidewalks that accommodate wheelchairs Which of the following elements does not need to be entered on the NEW Event Request Form when reporting a new event? Correct Answer: The event venue manager/contact person Jeff has an informal marketing/sales event scheduled this afternoon, but a consumer has requested an in-home appointment during that time. He would like to cancel or reschedule the event because he is certain to get an enrollment application at the appointment. Which of the statements below is correct about Jeff's event? Correct Answer: Jeff is prohibited from canceling the event because it is within 1 business day and is not due to inclement weather. Jeff must hold his event or he could work with his manager to get a replacement to conduct the event. On October 1, Sam reported the formal marketing/sales event he has scheduled for 9 a.m. on November 19. Luckily, before he had flyers printed, he remembered he has an 8 a.m. dentist appointment November 19. Just to make sure he can get to his event on time, he advertises the event to start at 9:30 a.m. What event reporting infraction(s) might Sam incur? Correct Answer: (INCORRECT) None, Sam reported the event prior to advertising and not less than 7 calendar days prior to the date of the event Marcus is planning an educational event and has decided to place an advertisement in the local paper. What must the advertisement include? Correct Answer: A statement that makes it clear that the event is for educational purposes only. Which of the following food and beverage options may be provided at an educational event if the nominal retail value of the items when combined with

Which of the following best describes the purpose of event observation? Correct Answer: An oversight activity where an individual evaluates an event as a means to ensure the information provided by the agent was accurate and compliant. Which of the following statements describes compliant activity during a formal marketing/sales event? Correct Answer: Not one plan fits all Which of the following statements is true about conducting a formal marketing/sales event in a conference room inside a UnitedHealthcare MedicareStore? Correct Answer: All rules relating to formal marketing/sales events apply including event reporting and providing a complete plan presentation. When must an agent inform the consumer of the availability of no-cost interpreter services? Correct Answer: Whenever the agent is presenting a Medicare Advantage or Prescription Drug Plan.