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

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UHC Medicare Certification Exam ( 2024 /2025) | Actual Questions and

Answers Latest Updated 2024/2025 (Graded A+)

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? March 1 through July 31 April 1 through October 31 July 1 through December 30 June 1 through July 31 - ✔✔Not July 1 - Dec 30 - WRONG April 1 through October 31 - CORRECT Annual Election Period (AEP) is a time when... Consumers can only disenroll from their Medicare Advantage or Prescription Drug Plan and return to Original Medicare. Consumers can only enroll in a Medicare Advantage Plan or switch to a different Medicare Advantage plan. Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Only certain Medicare-eligible consumers can make changes. - ✔✔Consumers can elect to switch to a different plan or join a Medicare Advantage plan or Prescription Drug Plan. Which statement regarding Star Ratings is true? Medicare uses a 5-star rating system to illustrate a plan's performance and quality. The agent said that the Star Ratings are based on a plan's performance from two years ago and, therefore, do not accurately reflect a plan's current value. Star Ratings are based on a plan's performance from the prior year and, therefore, may not accurately reflect a plan's current value. Medicare uses a 5-star rating system to illustrate the plan's relative popularity in a market as measured by membership and retention rates. - ✔✔Medicare uses a 5-star rating system to illustrate a plan's performance and quality.

Which of the following is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? Emailing a marketing brochure to a consumer whose email address was obtained on a purchased lead list. Approaching a consumer in a common area of a senior living complex. Placing a marketing brochure on the door handle of the consumer's residence. Mailing a marketing brochure to the consumer via postal mail. - ✔✔Mailing a marketing brochure to the consumer via postal mail What information should be obtained from the consumer when conducting a thorough needs assessment? (Select 2) The providers they see and medications they take to determine network and formulary status. Their current health care coverage, including what they like about it and what they don't. Their favorite foods and hygiene products to determine if they are covered by a grocery allowance - ✔✔The providers they see and medications they take to determine network and formulary status. Their current health care coverage, including what they like about it and what they don't. 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 enrollment application may be denied. The consumer/member would not receive plan related correspondence intended for him/her. The agent may experience commission payment processing issues. - ✔✔The consumer/member would not receive plan related correspondence intended for him/her What is the purpose of the Statement of Understanding? It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding of monthly premiums and deductibles. It ensures that when consumers sign the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding of standard enrollment and disenrollment procedures. It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan

they are enrolling, and standard disclosures. - ✔✔It ensures that when consumers complete the Medicare Advantage and/or Part D Enrollment Application, they are acknowledging their understanding that they are actually enrolling, in which plan they are enrolling, and standard disclosures Which of the following must an agent obtain from the consumer no less than 48 hours (unless an exception applies) before an in-person, online, or telephonic marketing appointment? Scope of Appointment Statement of Understanding Permission to Call - ✔✔Scope of Appointment Which statement is accurate when a consumer has a Power of Attorney (POA)? The POA may attend a personal/individual marketing appointment with the consumer but has no authority to sign the Enrollment Application. If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under state law to enroll the consumer. The POA may sign the Enrollment Application and must submit documentation that indicates his authority under state law to enroll his mother with the application. - ✔✔If the POA signs the Enrollment Application, they must be able to provide documentation upon request by the Plan that indicates authority under state law to enroll the consumer. Select the option that describes the coverage combinations a member can be enrolled in at the same time. MA-Only PFFS plan and a stand-alone PDP MA-Only non-PFFS plan and a stand-alone PDP Medicare Supplement plan and MA-PD plan - ✔✔Medicare Supplement plan and MA-PD plan - WRONG In which situation will a member be involuntarily disenrolled from their MA plan? The member lost entitlement to either Medicare Part A or Part B. The member did not pay plan premiums on a timely basis. The member engaged in disruptive behavior. Premiums are not paid on a timely basis. - ✔✔The member lost entitlement to either Medicare Part A or Part B.

Rosanna is enrolled in a Medicare Advantage Only (MA-Only) Private Fee-for-Service (PFFS) Plan. The plan is suitable for her needs and service area. She has decided she wants to add prescription drug coverage. Which option is available to Rosanna (assuming she is in a valid election period)? Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP. Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Advantage Prescription Drug (MA-PD) plan. Rosanna could disenroll from her MA-Only PFFS plan and enroll in an MA-Only HMO plan and a stand- alone PDP. Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Supplement Plan. - ✔✔Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a Medicare Advantage Prescription Drug (MA-PD) plan. - WRONG Rosanna could stay enrolled in her MA-Only PFFS plan and enroll in a stand-alone PDP - CORRECT In what product should agents enroll consumers? A product that meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. A product that provides a financial advantage to a network of providers. A product that meets the interest the agent has in the transaction, for example commissions received for the sale. A product that is suitable for the consumer's needs, goals and financial resources. - ✔✔A product that is suitable for the consumer's needs, goals and financial resources. Why must an agent present accurate, complete, and factual plan information to consumers? (Select 3) To help avoid confusing the consumer To help the consumer focus on plan-specific information, such as benefits and costs To help the consumer gain confidence in the agent's expertise To help avoid misunderstandings - ✔✔To help avoid confusing the consumer To help the consumer focus on plan-specific information, such as benefits and costs To help avoid misunderstandings

Which statement about discussing benefits with the consumer before an enrollment is true? The agent does not need to cover any benefits, provided the Summary of Benefits is emailed to the consumer. The agent does not need to disclose the monthly premium. The agent only needs to review benefits in which the consumer is interested. The agent must explain any provider and/or pharmacy network limitations. - ✔✔The agent only needs to review benefits in which the consumer is interested. - WRONG Whose email address may the agent enter into the applicant information section of the LEAN enrollment application? - ✔✔Only the Consumer's email When must the Scope of Appointment be obtained from the consumer for an in-person or telephonic sales presentation (unless an exception applies)? No less than 48 hours before the marketing appointment Anytime during the marketing appointment When the marketing appointment has concluded Before the start of a marketing appointment - ✔✔No less than 48 hours before the marketing appointment What happens on the plan effective date when a member enrolled in a Medicare Supplement Insurance Plan and stand-alone PDP enrolls in a Medicare Advantage plan that includes drug coverage? Automatic disenrollment from the Medicare Supplement Insurance Plan and the stand-alone PDP. Automatic disenrollment from the stand-alone PDP. Automatic disenrollment from the Medicare Supplement Insurance Plan. - ✔✔Automatic disenrollment from the Medicare Supplement Insurance Plan and the stand-alone PDP. In which situation MAY the Medicare Advantage (MA) organization decide to disenroll a member from an MA plan? The member expresses dissatisfaction with the plan

Premiums are not paid on a timely basis - ✔✔Premiums are not paid on a timely basis Dennis, a consumer, is currently enrolled in Original Medicare plus a Medicare Supplement Plan. His current plan is suitable for his medical needs, but he would like to add prescription drug coverage only. Since Dennis wants to keep his current coverage, which option is available to Dennis (assuming he is in a valid election period)? Dennis should stay enrolled in his Medicare Supplement Plan and enroll in a Medicare Advantage Plan with prescription drug coverage included. Dennis should disenroll from his Medicare Supplement Plan, return to Original Medicare and enroll in a stand-alone PDP. Dennis should disenroll from his Medicare Supplement Plan and enroll in any of the Medicare Advantage Plans that have prescription drug coverage included. Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. - ✔✔Dennis should stay enrolled in Original Medicare and his Medicare Supplement Plan and enroll in a stand-alone PDP. 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? Dino refused to take the enrollment application until October 15. Dino presented a plan prior to October 1. Dino did nothing that was non-compliant. - ✔✔Dino presented a plan prior to October 1. On October 20, Aries decides to switch his PDP to a Medicare Advantage plan. Aries would like this change to be effective November 1. Which statement is true for Aries? He may be able to use a Special Election Period to change plans if he qualifies for one. He can use the Annual Election Period that runs from October 15 to December 7 and select November 1 as his plan effective date. He can use the Medicare Advantage Open Enrollment Period that runs from October 15 to December 7 and select November 1 as his plan effective date. There are no rules governing how often he can change plans during the year. - ✔✔He may be able to use a Special Election Period to change plans if he qualifies for one.

Which of the following statements is true about election periods? Annual Election Period can only be used by a consumer already enrolled in an MA Plan. MA Open Enrollment Period can only be used by a consumer already enrolled in an MA Plan 5 - Star SEP can only be used by a consumer already enrolled in an MA Plan. Initial Election Period can only be used by a consumer already enrolled in a Medicare Advantage (MA) Plan. - ✔✔ 5 - Star SEP can only be used by a consumer already enrolled in an MA Plan. WRONG While using LEAN to complete an enrollment application with a consumer, Agent Jeff learns the consumer does not have an email address. What should Jeff do? Leave the field requesting a consumer email address blank. Enter his own email address and then print out and mail to the consumer any correspondence received. Ask the consumer for the email address of a friend or relative, so that person can print out any correspondence received for the consumer. - ✔✔Leave the field requesting a consumer email address blank. To complete an Enrollment Application on behalf of a consumer, what authority must the individual have? The individual must be legally authorized by the federal government to act on behalf of the consumer. The individual must have the verbal consent of the consumer. The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). The individual must only be a spouse or an adult child of the consumer. - ✔✔The individual must be legally authorized in the state in which the consumer resides to act on behalf of the consumer (e.g., Power of Attorney). Which of the following options will enable a consumer to obtain prescription drug coverage? (Select 2) Enroll in any MA plan and a stand-alone PDP Enroll in a PFFS MA-Only plan and a stand-alone PDP Enroll in any MA-PD plan - ✔✔Enroll in any MA plan and a stand-alone PDP Enroll in a PFFS MA-Only plan and a stand-alone PDP

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? Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. Aries can disenroll from his PDP and enroll into a Medicare Supplement plan. Aries can stay enrolled in his PDP and enroll into a Medicare Advantage Plan. Aries can disenroll from Original Medicare and enroll into a Medicare Advantage plan with prescription drug coverage. - ✔✔Aries can enroll into a Medicare Advantage plan with prescription drug coverage, which will disenroll him from his PDP. To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) Unsubstantiated Factual Accurate Complete - ✔✔Factual Accurate Complete Which of the following statements is true about using a 5-Star Special Enrollment Period (SEP)? It can be used once per quarter during the first nine months of the year and coverage will start the first of the month following receipt of the enrollment application. It can be used once from December 8 through November 30 to enroll in or disenroll from a 5-Star plan and the election will take effect the first of the month following receipt of the election request. It can be used once from December 8 through November 30 and coverage will start the first of the month following receipt of the enrollment application. - ✔✔It can be used once from December 8 through November 30 and coverage will start the first of the month following receipt of the enrollment application. When a consumer asks why an MA Plan has a 2-star rating, the agent should tell the consumer what? That is the plan's performance from the prior year and, therefore, may not accurately reflect a plan's current value.

That the plan has received a "Below Average" rating. That the Plan isn't very popular in the market as measured by membership and retention rates. - ✔✔That the plan has received a "Below Average" rating. Which of the following describes Permission to Contact (PTC) guidelines? PTC expires the Dec. 31 of each year regardless of when it was obtained. Contact can only be made by the method(s) requested by the consumer and the agent can only market the product(s) indicated by the consumer. The agent must obtain PTC no later than the start of a marketing appointment and can only discuss the products agreed upon by the consumer. - ✔✔Contact can only be made by the method(s) requested by the consumer and the agent can only market the product(s) indicated by the consumer. Which statement about discussing benefits with the consumer before an enrollment is true? The agent does not need to disclose the monthly premium. The agent only needs to review benefits in which the consumer is interested. The agent must explain any provider and/or pharmacy network limitations. The agent does not need to cover any benefits, provided the Summary of Benefits is emailed to the consumer. - ✔✔Which statement about discussing benefits with the consumer before an enrollment is true? - WRONG 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. Authorized Representative Disclaimer Disclosure of Benefits Statement of Understanding Permission to Contact - ✔✔The Statement of Understanding