UHC Certification Exam (2024/2025) | Actual Questions and Answers Latest Updated 2024/2025, Exams of Community Health

Download UHC Certification Exam (2024/2025) | Actual Questions and Answers Latest Updated 2024/2025 and more Exams Community Health in PDF only on Docsity! UHC Certification Exam (2024/2025) | Actual Questions and Answers Latest Updated 2024/2025 (Graded A+) 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? - ✔✔Part A - ✔✔The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - ✔✔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? - ✔✔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.) - ✔✔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) - ✔✔ 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 Which is true about Medicare Supplement Open Enrollment? - ✔✔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? - ✔✔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? - ✔✔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: - ✔✔Medicare Parts A and B Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? - ✔✔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) - ✔✔ Which of the following statements is not true about the Coverage Gap? - ✔✔All members reach the Coverage Gap Which of the following options are drug utilization management (UM) rules? (Select 3) - ✔✔ Which of the following best describes the Late Enrollment Penalty (LEP)? - ✔✔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? - ✔✔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? - ✔✔Drug tiers The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers. When does Medicare Supplement Open Enrollment take place? During the three months prior to the consumer's 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B. During the first six months a consumer is 65 or older and enrolled in Medicare Part B. Annually from October 15 to December 7. During the first three months a consumer is 65 or older and enrolled in Medicare Part B. - ✔✔During the first six months a consumer is 65 or older and enrolled in Medicare Part B. How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? 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. The OOP maximum is a feature that limits the amount of money a consumer will have to spend on all health care services each year. The OOP maximum is a feature that limits the amount of money a consumer will have to spend on prescription drugs and plan premiums each year. - ✔✔ 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 should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy. When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel. The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application. The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with 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 should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy. 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 hospitalization coverage. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage. - ✔✔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 statements is true about eligibility requirements for Medicare Prescription Drug Plans? Consumers must live in the same zip code as the pharmacy they intend to use A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B A consumer must receive a pension from a former employer Consumers do not need to live in the plan's service area - ✔✔A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage? They could sign up for a pharmacy savings card through their local pharmacy. There is no other way a Medicare consumer could get Part D prescription drug coverage. They could enroll in a Medicare Supplement Insurance Plan. They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage. - ✔✔They could 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? The catastrophic coverage stage is when the member will only pay a small coinsurance or copayment for covered drugs for the remainder of the plan year. Initial coverage is the stage when the plan pays part and the member pays part, usually as coinsurance or copayments. A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. The coverage gap ends when the member has spent $6,550 (in 2021) in out-of-pocket expenses for the plan year. - ✔✔A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. Which of the following options are drug utilization management (UM) rules? (Select 3 - ✔✔Quantity Limit Prior Authorization Step Therapy 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 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? Through a combination of subsidies and annual refund checks Through subsidies such as lower or no monthly plan premiums and lower or no copayments Such financial assistance will no longer be available as of January 1, 2020 By receiving annual checks with a refund based on a predetermined percentage of Part D costs - ✔✔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? - ✔✔Drug tiers Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies?