UNITED HEALTHCARE Certification Exam Testbank 1300+ Questions with Correct Answers, Exams of Public Health

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UNITED HEALTHCARE Certification Exam

Testbank 1300+ Questions with Correct

Answers 2023 - 2024 Update Graded A+++

The value proposition for the AARP brand is seen in what kinds of benefits for the members? (Select 3) Correct Answer/s- Quality of products offered. Efforts to improve the lives of members. Security and reputation of the AARP name. Agent Rita Garcia must not do which of the following while conducting a marketing/sales event? Correct Answer/s- State the plan she is presenting is the best plan on the market. At an informal marketing/sales event, which of the following activities is not permitted? Correct Answer/s- Approaching consumers as they pass by your booth/kiosk/table Agent Santana has developed a relationship with Dr. Westberry, a Primary Care Provider contracted with several Medicare Advantage Plans. Dr. Westberry is asked to attend a formal marketing/sales event conducted by Agent Santana. Which of Dr. Westberry's actions is non-compliant? Correct Answer/s- Offers blood pressure screenings as consumers wait for the event to begin Which of the following best describes the purpose of event observation? Correct Answer/s- 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 is true about conducting a formal marketing/sales event in a conference room inside a UnitedHealthcare MedicareStore? Correct Answer/s- 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/s- Whenever the agent is presenting a Medicare Advantage or Prescription Drug Plan. Sandra is currently enrolled in a Medicare Advantage plan that offers a variety of benefits beyond what is covered by original medicare, such as transportation to appointments and an over-the-counter debit card. When comparing an alternative

plan, which of the following must you not use to describe benefits of the new plan? Correct Answer/s- Nothing will change or everything will be the same Consider Lili tells you she is enrolled in a Medicare Advantage plan where she is required to see in-network providers to receive coverage, except in emergencies. She is interested in a plan that offers more network flexibility, provided she can see her current Primary Care Provider (PCP). Which of the following best describes steps you must take in your sales and enrollment process? (select 3) Correct Answer/s- I must compare with the consumer any plan I recommend to their current MA plan, including benefits, costs, network, and drug coverage. I must complete a thorough needs assessment I must ensure the consumer understands what they are gaining and what they may be giving up by enrolling in the new plan. When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? a) The month after they are notified by the plan of the loss of Medicaid eligibility b) Upon notification or effective date of the loss, whichever is earlier c) After the grace period ends d) Six months after they have been disenrolled from the DSNP Correct Answer/s- b) Upon notification or effective date of the loss, whichever is earlier Which consumer might benefit the most by enrolling in a DSNP? a) Alice, who is a Specified Low-Income Medicare Beneficiary (SLMB) b) Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) c) Alvin, who has a Medicare Supplement Insurance policy d) Elsa, who pays a Part D income-related monthly adjustment amount (IRMMA) Correct Answer/s- b) Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)

Which statement best describes a care management program that varies depending upon the level of the member's health risk? a) Support provided only to DSNP members that may have unique health care needs b) Support provided only to CSNP members that may have unique health care needs c) Support provided only to members who have multiple chronic conditions and receive state Medicaid benefits d) Support provided to CSNP and DSNP members that may have unique health care needs Correct Answer/s- Which statement best describes a DSNP? a) DSNPs are non-network based plans, which enables members to see any Medicare-eligible provider b) DSNPs do not include prescription drug coverage, so a member may enroll in a stand-alone Prescription Drug Plan in addition to their DSNP c) The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs d) The state government pays half of the plan premium Correct Answer/s- c) The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs When selling DSNPs, agents must: a) Ensure that the consumer only has Medicare b) Tell the consumer that the DSNP is a zero-dollar premium plan c) Inform the consumer that the state Medicaid program will pay the Medicare Advantage premiums or copayments d) Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Correct Answer/s- d) Confirm the

consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B The consumer states they currently pay a percentage of charges when they receive medical care. This means: a) The consumer is enrolled in a Medicare Supplement Insurance Plan. b) The consumer is not likely to be a Full Dual-Eligible; however, the DSNP is always the best option in which to enroll this consumer. c) The consumer is most likely a Full Dual-Eligible; you can proceed with enrollment in a DSNP. d) The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan. Correct Answer/s- d) The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan. The following is a characteristic of consumers for whom a CSNP may be most appropriate: a) Consumers who are still working and receive health care coverage through their employer or union b) 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 c) Consumers who have Medicare and Medicaid d) Consumers who have resided in a contracted Skilled Nursing Facility for more than 90 days Correct Answer/s- b) 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 John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition.

Can John enroll in a Chronic Special Needs Plan (CSNP) that covers his chronic condition? a) No, he can only enroll during the Annual Election Period (AEP) b) Yes, he can enroll using Medicare Supplement Insurance Guaranteed Issue c) Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) d) No, he can only enroll during the Medicare Advantage Open Enrollment Period (OEP) Correct Answer/s- c) Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? a) All of the responses are correct. Initial Health Assessment b) Individualized plan of care c) Interdisciplinary Care Tea d) Ongoing reassessment of risk level for status changes Correct Answer/s- a) All of the responses are correct. Initial Health Assessment Which of the following must you ensure a consumer who is making a plan change understands? (Select 2) Correct Answer/s- I must make sure the consumer understands the benefits, costs, and limitations of the new plan I must make sure the consumer understands what they are giving up by enrolling in the new plan I'm recommending Which of the following consumers are eligible for Medicare if other eligibility requirements are met? Correct Answer/s- 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 best describes a "like" plan change? Correct Answer/s- When a consumer enrolls in a plan that is of the same type as their current plan, such as any medicare advantage plan to any other medicare advantage plan which of the following is not true about UnitedHealth Care Medicare plans carrying the AARP name? Correct Answer/s- AARP endorses UnitedHealth Care MA, PDP, and Medicare supplement plans AARP expects agents offering AARP-branded products to demonstrate 5 key behaviors when interacting with customers. AARP wants customers we work with to feel their relationship with AARP is _________________ Correct Answer/s- Effortless and inspiring Which of the following are part of being straightforward when servicing a customer? Correct Answer/s- Communicating clearly to alleviate any confusion Being upfront about what information means providing the right information Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealth Care? Correct Answer/s- yes, if the consumer is enrolling in a medicare supplement plan How many status levels are in the Authorized to offer program? Correct Answer/s- 2 which of the following statements about AARP are true? (select 2) Correct Answer/s- The AARP motto is to serve, not be served AARP advocates for the 50+ population in congress for legislation to lower medical costs which of the following is true about the production requirement for the authorized to offer Elite status? Correct Answer/s- Each calendar year, agents need to have at least 30 commission-eligible, accepted, and paid AARP medicare supplement plan and / or medicare select plan sales or retain a book of business of 150 or more active members

The value proposition for the AARP brand is seen in what kinds of benefits for the members (select 3)? Correct Answer/s- ensuring products are well below the going market rate efforts to improve the lives of members quality of products offered Which AARP brand medicare products does UnitedHealth Care offer? (select 3) Correct Answer/s- Prescription drug plans medicare advantage plans mediare supplement plans The 3 types of special needs plans are Correct Answer/s- dual, chronic condition and institutional / institutional-equivalent. When does the special election period for dual / LIS change in status begin for D- SNP members that lose medicaid eligibility? Correct Answer/s- Upon notification or effective date of the loss, whichever is earlier which statement describes the primary characteristic of a consumer who may benefit from a D-SNP? Correct Answer/s- Is enrolled in their state Medicaid program, typically as a full dual, with their Medicare cost sharing paid by the state in which they reside. which program is available to support the unique health care needs of C-SNP and D-SNP members? Correct Answer/s- A care management program that varies depending upon the level of the member's health risk level which statement is true about C-SNPs, D-SNPs, and prescription drug coverage? Correct Answer/s- C-SNPs and D-SNPs include Medicare part D prescriptions drug coverage. when selling D-SNPs, agent must: Correct Answer/s- confirm the customer's medicaid level and that the consumer is entitled to Medicare part A and enrolled in part B

The consumer states they currently pay a percentage of charges when they receive medical care. This means Correct Answer/s- The consumer is not likely to be a full dual-eligible and may be better suited for enrollment in another type of plan which of the following consumer characteristics demonstrates a good fit for a C- SNP? Correct Answer/s- A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs On May 10, Michael meets with an agent and says he is enrolled in another carrier's C-SNP due to his diabetes. When can Michael enroll in a different C-SNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area? Correct Answer/s- During the annual election period (AEP) or open enrollment period (OEP) which service will a C-SNP or D-SNP member in the high risk care management category receive? Correct Answer/s- Case management ( telephonic, digital and / or face to face) according to individual needs it is very important for consumers enrolling in a C-SNP to know the following about accessing providers: Correct Answer/s- some C-SNP are preferred provider organization (PPO) or point service (POS) plans that allow members to see out of network providers for covered services, generally with higher cost sharing. which statement is true about the Medicaid program? Correct Answer/s- It helps pay medical costs for certain groups of people with limited income and resources. Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition Correct Answer/s- at the end of her second month of enrollment member who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing? Correct Answer/s- All, such as premiums, deductibles, copayments, and coininsurance. which statement is true of D-SNP members? Correct Answer/s- 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

Inez, a consumer, called the number on a piece of mail she received during the Annual Election Period. When you answer, you can hear a lot of background noise. What actions should you take to help ensure Inez will understand the information you share with her? (select 3) Correct Answer/s- Ask her to either move into another room or turn off the TV to help her hear me clearly and without distraction Ask if someone assists her with making enrollment decisions and make sure that person is present to participate in the call Speak clearly, at an appropriate volume, and at a moderate pace. Which of the items listed are examples of Fraud, Waste, and Abuse (FWA)? (Select 3) Correct Answer/s- Submitting claims for services or supplies that were never provided. Billing for brand name drugs when generics were dispensed. Consulting with a number of doctors in order to obtain multiple prescriptions for the same drug. Name the abbreviation: PA Correct Answer/s- physician assistant What is a physician's assistant licensed to do? Correct Answer/s- practice medicine with physician supervision T/F: Physicians assistants can prescribe CII medications without physician authorization Correct Answer/s- false Name the abbreviation: RA Correct Answer/s- radiologist assistant What is a radiologist assistant? Correct Answer/s- an advanced level radiologic technologist who extends the capacity of the radiologist Name the abbreviation: OT Correct Answer/s- occupational therapist What is an occupational therapist? Correct Answer/s- a professional who treats injured, ill, or disabled patients through the therapeutic use of everyday activities to improve their daily life

Name the abbreviation: APRN Correct Answer/s- advanced practice registered nurse What is required to become an APRN Correct Answer/s- a few years of experience and a nursing graduate degree T/F: APRNs cannot specialize Correct Answer/s- false Name the abbreviation: NP Correct Answer/s- nurse practitioner Name the abbreviation: ACNP Correct Answer/s- acute pediatric care nurse practitioner Name the abbreviation: ACNPCAG Correct Answer/s- adult gerontology acute care nurse practitioner Name the abbreviation: CNM Correct Answer/s- certified nurse midwife Name the abbreviation: CRNA Correct Answer/s- certified registered nurse anesthetists Name the abbreviation: CNS Correct Answer/s- certified nurse specialist Name the abbreviation: RT Correct Answer/s- respiratory therapist what is the purpose of a needs assessment Correct Answer/s- To gather as much information about the consumer as possible to ensure I am recommending the plan that is the best fit for the consumer What is the purpose of a respiratory therapist? Correct Answer/s- to diagnose lung and breathing disorders, recommend treatments, and manage ventilators/ artificial airway devices Name the abbreviation: MD Correct Answer/s- Doctor of Medicine What does a Doctor of Medicine do? Correct Answer/s- someone who diagnosis, treats, and performs surgery T/F: MDs cannot specialize Correct Answer/s- false

What is an allopathic physician? Correct Answer/s- one that diagnoses or treats with medication or surgery Name the abbreviation: DO Correct Answer/s- doctor of osteopathic medicine What does a doctor of osteopathic medicine do? Correct Answer/s- diagnose/ treat patieitns and perform surgery T/F: DOs can specialize Correct Answer/s- true What is an osteopathic physician? Correct Answer/s- one that regards the body as an integrated whole rather than treating for specific symptoms only Name the abbreviation: DC Correct Answer/s- doctor of chiropractic T/F: Chiropractics is a drug free and non-surgical science Correct Answer/s- true T/F: doctors of chiropractic can prescribe medication Correct Answer/s- false What is the goal of a doctor of chiropractic? Correct Answer/s- to adjust the structure of the body to improve function Name the abbreviation: DDS Correct Answer/s- Doctor of Dental surgery T/F: DDS and DMD are the same degree Correct Answer/s- true T/F: DDS cannot prescribe medications Correct Answer/s- false T/F: DDS can pursue residency training to specialize? Correct Answer/s- true Name the abbreviation: DVM Correct Answer/s- Doctor of Veterinary Medicine What can a DVM do? Correct Answer/s- treat, diagnose, and perform surgery T/F: DVMs can prescribe medications for animals even if it is an off-label use Correct Answer/s- true Name the abbreviation: DPM Correct Answer/s- doctor of podiatric medicine

What does a DPM focus on? Correct Answer/s- foot, ankle, and related structures of the leg T/F: a DPM cannot prescribe medication Correct Answer/s- false Name the abbreviation: CDE Correct Answer/s- Certified Diabetes educator What does a CDE do? Correct Answer/s- educate on diabetes self management Name the abbreviation: BCACP Correct Answer/s- Board Certified Ambulatory Care pharmacist Name the abbreviation: BCCCP Correct Answer/s- Board Certified Critical Care Pharmacist Name the abbreviation: BCNP Correct Answer/s- Board Certified Nuclear Pharmacist Name the abbreviation: BCNSP Correct Answer/s- Board certified nutrition support pharmacist Name the abbreviation: BCOP Correct Answer/s- Board certified oncology pharmacist Name the abbreviation: BCPPS Correct Answer/s- board certified pediatric pharmacy specialist Name the abbreviation: BCPP Correct Answer/s- board certified psychiatric pharmacist Name the abbreviation: BCIDP Correct Answer/s- board certified infectious diseases pharmacist Name the abbreviation: BCCP Correct Answer/s- board certified cardiology pharmacist Name the abbreviation: BCGP Correct Answer/s- Board Certified Geriatric Pharmacist

Name the abbreviation: BCSCP Correct Answer/s- Board Certified Sterile Compounding Pharmacist Name the abbreviation: BCTXP Correct Answer/s- Board Certified Transplant Pharmacist Name the abbreviation: BCPS Correct Answer/s- Board Certified Pharmacotherapy Specialist Educational events allow for which of the following to occur? Provide objective information about the Medicare program and/or health improvement and wellness. Provide an opportunity to review benefits, premiums and product information with consumers. Provide an opportunity to steer a consumer toward a specific or limited number of plans. Provide an opportunity to give an introductory presentation followed by an informal marketing/sales event. Correct Answer/s- Provide objective information about the Medicare program and/or health improvement and wellness. Which of the following describes Permission to Contact guidelines? It allows the agent to discuss the products identified during the marketing appointment. It does not have to be provided by the consumer, but can be provided by the consumer's spouse or adult child. It is method specific, (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified). Correct Answer/s- It is method specific, (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified). Janine, currently enrolled in a 3-star plan, discovers there is 5-star plan available where she lives. She asks her agent, Josh, to enroll her in the 5-star plan. Josh can advise Janine of each of the following except: Correct Answer/s- Josh should tell Janine that she can only change her current plan to a 5 star plan during the Annual Election Period.

Agent Ralph wants to market Medicare Advantage Plans in his neighborhood - an area that consists of single-family houses, an assisted living facility, a church, and public library. Which of the following methods of contact is permitted? Ralph sends a flyer inviting consumers to a marketing/sales event to each resident via postal mail. Ralph stands in the lobby of the assisted living facility and hands out to the residents a flyer inviting them to a marketing/sales event. Ralph puts a flyer inviting consumers to a marketing/sales event on the door of each house. Ralph puts a flyer inviting consumers to a marketing/sales event on the windshield of each car in the church parking lot on Sunday morning. Correct Answer/s- Ralph sends a flyer inviting consumers to a marketing/sales event to each resident via postal mail. An individual with Power of Attorney is an example of what authority? Permission by the health plan to act on behalf of a consumer or member. Legal authority under state law to act on behalf of another individual. Legal authority under federal law to act on behalf of another individual. Permission by the consumer to act on their behalf. Correct Answer/s- Legal authority under state law to act on behalf of another individual. whose email address may the agent enter into the applicant information section of Lean enrollment application Correct Answer/s- Only the consumer's email what is the purpose of the statement of understanding for medicare Correct Answer/s- 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 is not considered unsolicited contact with a Medicare eligible consumer according to CMS regulations and UnitedHealthcare's rules, policies, and procedures? Mailing a marketing brochure to the consumer via postal mail. 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. Correct Answer/s- Mailing a marketing brochure to the consumer via postal mail.

Who has the authority to sign an Enrollment Application? The consumer, the consumer's spouse, or the consumer's adult child. The consumer or any individual authorized by the consumer. The consumer only. The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). Correct Answer/s- The consumer or the consumer's authorized legal representative (e.g., Power of Attorney). When marketing UnitedHealthcare Medicare Advantage plans to consumers, which of the following must an agent do? Review and complete an SOA form with each consumer after a personal/individual (e.g., in-home or telephonic) marketing appointment. Provide current marketing materials that have been approved by CMS and UnitedHealthcare. Provide only the information for which the consumer asks. Review the Summary of Benefits only upon request. Correct Answer/s- Provide current marketing materials that have been approved by CMS and UnitedHealthcare. As an agent, you have an obligation to only enroll a consumer in a product: That provides a financial advantage to a network of providers. That meets the sales goal of the Centers for Medicare and Medicaid Services, UnitedHealthcare and the Social Security Administration. That is suitable for the consumer's needs, goals and financial resources. That meets the interest you have in the transaction, for example commissions received for the sale. Correct Answer/s- That is suitable for the consumer's needs, goals and financial resources. 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 that they will continue to receive materials and information at the agent's discretion. 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 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 that they are actually enrolling, in which plan they are enrolling, and standard disclosures. Correct Answer/s- It ensures that when consumers sign 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. What is the definition of Fraud? Fraud includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources. Fraud includes any practice that results in the provision of services that are not medically necessary. Fraud is intentionally misrepresenting or concealing facts to obtain something of value. Correct Answer/s- Fraud is intentionally misrepresenting or concealing facts to obtain something of value. which of the following are examples of phrases that must not be spoken by an agent when a consumer is contemplating a plan change? (select 2) Correct Answer/s- everything will be the same nothing will change Which of the following best describes why it is important to compare plan options to the consumer's current coverage? Correct Answer/s- I want to make sure the consumer understands what they give up and what they gain by changing plans. What are examples of phrases you should avoid using with a consumer when comparing plans? (select 3) Correct Answer/s- Everything will be the same I am recommending a plan that will add benefits to your current coverage nothing will change What should the consumer understand before they agree to proceed with enrolling in a new plan? (select 3) Correct Answer/s- Their current plan and the new plan that I am recommending are not the same

if the plan has drug coverage, that the medications they use are on the plan's formulary and, it they are, what tier they are in and any utilization management limitations If the plan is network-based, that the providers they want to use are in the new plan's network. Which of the following guidelines must you follow before recommending a plan change Correct Answer/s- Only recommend a plan that is the best fit plan, which may be the consumer's current plan Conduct a thorough needs assessment Do not rely only on and become biased by the consumer's stated reason for calling Simon is currently enrolled in a Medicare advantage plan. He calls saying he saw an ad on TV that says he can get a plan with dental coverage of $3500 per year. What guidelines must you follow before recommending a new plan to Simon? (select 3) Correct Answer/s- Do not rely only on and become biased by the consumer's stated reason for calling conduct a thorough needs assessment to gather comprehensive information related to the consumer's situation and needs Only recommend a plan that is the best fit plan, which may be the consumer's current plan Which of the following are components that, at minimum, should be included in a thorough needs assessment (select 3) Correct Answer/s- Identifying their current providers (including primary care, specialists, hospitals, and pharmacies) and the medications they take Determining consumer eligibility learning about their current coverage, lifestyle and financial characteristics Which of the following are the ways to report potential FWA? (Select 2) Fraud, Waste and/or Abuse hotline Local law enforcement Text message to the member

Producer Help Desk (PHD) Correct Answer/s- Fraud, Waste and/or Abuse hotline Producer Help Desk (PHD) Can a consumer who qualifies for low Income Subsidy receive financial assistance for their part of Medicare Part D costs? Correct Answer/s- Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments What is the amount added to the member's monthly plan..........ect Correct Answer/s- Late Enrollment Penalty (LEP) What are two options for Medicare consumers to get Part D prescription drug coverage (Select 2) Correct Answer/s- Enroll in a Medicare Advantage Plan or other Medicare health plan that incudes prescription coverage and Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) When is Mary's Medicare Supplement Open Enrollment period is she turns 65 on September 23,2021, and her Medicare Correct Answer/s- September 2021 through February 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/s- HMO, POS, PPO Medications that are covered in a Plan's formulary have various levels Correct Answer/s- Out of pocket expenses Which statements true of Medicare Supplement Insurance Plans? Correct Answer/s- To see a specialist, insured members must obtain referrals from primary care providers. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Correct Answer/s- TRUE How does a consumer who qualifies for low income subsidy receive financial assistance for their part of Medicare Part D costs Correct Answer/s- Through subsides such as lower or no monthly plan premiums and lower copayments

Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA plan Correct Answer/s- Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore .....ect Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare? Correct Answer/s- Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility requirements. Lisa turned 65 and is now eligible for Medicare. She already receives Social Security Correct Answer/s- Her enrollment in Medicare Being 65 or older, being under 5 years of age with certain disabilities for more than 24 Correct Answer/s- Original Medicare Which of the following defines a Medicare advantage (MA) plan? Correct Answer/s- MA Plans are health plan options approved by Medicare and offered by private insurance companies Which of the following are true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select 2) Correct Answer/s- a. Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F. b. Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose. *Which of the following statements does Not correctly define prescription drug stages? Correct Answer/s- A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in. *Aside from a stand alone Medicare Prescription drug plan Correct Answer/s- They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage or

There is no other way a Medicare consumer could get Part d prescription drug coverage *Which of the following statements is true about eligibility requirements for stand- alone Medicare Prescription Drug Plans? Correct Answer/s- A consumer must be entailed to Medicare Part A and/ or enrolled in Medicare Part B

• Which of the following best defines Medicare Part D? Correct Answer/s- ect....... which provides prescription drug coverage Roger wants to know what counts toward the Out of pocket Maximum on the Medicare Correct Answer/s- The out of pocket maximum includes costs the member pays for any Medicare-covered Part A or B service When does Medicare supplement Insurance take place? Correct Answer/s- During the first six moths ***Which type of MA Plan is an HMO Plan that also covers some benefit out of network, generically at a higher costs. Correct Answer/s- Point of service (POS) Plan Janice wants to enroll in a Medicare Advantage plan Which of the following is NOT an Eligibility requirement? Correct Answer/s- Its not "Entailed to Medicare Part A" To be eligible for this plan type, consumers must meet the following requirements:

• Entitled to Medicare Part A and enrolled in Part B
• Reside in the plan's service area Which plan is being described? Correct Answer/s- Medicare Advantage A consumer currently has original Medicare and is enrolled in a stand alone Prescription drug coverage (PDP)? What will happen if the customer enrolls in an MA Plan that has integrated prescription drug coverage? Correct Answer/s- The consumer will be automatically disenrolled from their stand alone PDP upon enrollment in the MA plan that has integrated prescription drug coverage. Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare eligible consumers get part D prescription drug coverage Correct Answer/s- They could enroll in a stand alone Medicare Prescription drug coverage (PDP)

Which of the following best describes the Late Enrollment Penalty (LEP) Correct Answer/s- The amount added to the members monthly plan premium.....(63 or more continuous days) Which statement is an example of one that must appear on advertisements for educational events Correct Answer/s- for accommodation of persons with special needs call 555- 555 - 1234 tty 711 To avoid confusing or misleading a consumer, what type of information must the agent provide when presenting a plan? (Select 3) Correct Answer/s- Complete Accurate Factual *** Which of the following are examples of advertisements a consumer may see that may make them call into your call center? (Select 2) Correct Answer/s- A letter sent by your agency to the consumer's home Annual period notice which of the following marketing materials must not be displayed distributed or provided to consumers attending a marketing/sales event Correct Answer/s- non health related product brochures agent Rita Garcia must not do which of the following while conducting a marketing/sales event Correct Answer/s- state the plan she's presenting is the best plan on the market Which of the following statement is true about eligibility requirement for stand alone Medicare prescription drug plans? Correct Answer/s- b. A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B which of the following statements describes compliant activity during a formal marketing/sales event Correct Answer/s- the agent explained that each consumer's needs are different therefore they should each enroll in a plan that best meets their needs to ensure an event is cancelled in united healthcare's event reporting application by the reporting deadline was the last recommended date for submitting a cancel event

request form Correct Answer/s- submit the cancel event request form no later than six business days before the event which of the following giveaways is not permitted at an educational event assume nominal retail value is met Correct Answer/s- gift card to local movie theater which of the guidelines listed below is not allowed when accepting an enrollment application at a marketing/sales event Correct Answer/s- offer to hold an enrollment application and submit it later when must an agent inform the consumer of the availability of no cost interpreter services Correct Answer/s- whenever the agent is presenting a Medicare Advantage or prescription drug plan to ensure an event is cancelled in united healthcare's event reporting application by the reporting deadline what is the last recommended date for submitting a cancel event request form Correct Answer/s- submit the cancel event request form no later than six business days before the event which of the following statements is not a best practice for event scheduling changing or canceling Correct Answer/s- submit a new event request born after you have advertised your event to make sure you enter the right information at an informal marketing/sales event which of the following activities is compliant Correct Answer/s- waiting for consumers to approach the table/boot/kiosk Which part of Medicare helps with inpatient hospital stays, hospice care, and provides limited home health benefits? Correct Answer/s- Part B Part D Part A(Right) Part C Which of the following consumers would be eligible for Medicare? Correct Answer/s- - Consumers age 65 or older and consumers under 65 years of age with certain disabilities except for ESRD or ALS

• 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(right)
• Only consumers age 65 or older with certain disabilities and consumers of all ages with ESRD or ALS

• Consumers age 62 or older, consumers under 62 years of age with certain disabilities and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) Correct Answer/s- An MA Plan does not have to provide benefits equivalent to Original Medicare.(wrong)
• An MA Plans is part of Medicare and is also called Part C.(right)
• An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.(right)
• An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often include Medicare prescription drug coverage (Part D).(right Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she meet? (Select the two answers that apply.) Correct Answer/s- - Not have End Stage Renal Disease (permanent kidney failure)
• Reside in the plan's service area(right)
• Entitled to Medicare Part A and enrolled in Part B(right)
• Entitled to Medicare Part A and/or is enrolled in Part B Which type of MA Plan is an HMO plan that also covers some benefits out-of- network, generally at a higher cost? Correct Answer/s- Point-of-Service (POS) Plan(right) 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? Correct Answer/s- He may be able to use a Special Election Period to change plans if he qualifies for one. Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum? Correct Answer/s- All MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for Medicare-covered services. When does Medicare Supplement Open Enrollment take place? Correct Answer/s-
• During the first six months a consumer is 65 or older and enrolled in Medicare Part B.(right) A consumer with Original Medicare might be interested in an MA Plan because: Correct Answer/s- - MA Plans eliminate Medicare Part A premiums.
• By joining an MA Plan they will no longer be a part of the Medicare program.

• MA Plans typically provide additional coverage beyond Original Medicare and often have established copayments for some benefits.(right)
• It has a larger network of providers and skilled nursing facilities. Which of the following is a fact about Medicare Prescription Drug Plans? Correct Answer/s- - To enroll, the consumer must reside in the plan's service area
• All drugs are covered
• Medicare Part D is part of Medicare Supplement Insurance Plans
• Benefits never vary by plan(wrong) Which of the following statements is not true about the Coverage Gap? Correct Answer/s- - For 2021, the coverage gap begins when the member has incurred $4,130 in medication spending for the year
• The use of lower cost generic medications may prevent the member from reaching the coverage gap
• All members reach the Coverage Gap(right)
• Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium
• If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications The new MACRA legislation, which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. Correct Answer/s- TRUE(right) FALSE 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/s- The consumer/member would not receive plan related correspondence intended for him/her. Mr. and Mrs. Nelson, who are current members, unexpectedly walk into Jake's insurance agency office and ask him to discuss Medicare Advantage Plans. Does Jake need to obtain a Scope of Appointment (SOA) form? Correct Answer/s- Yes, he needs to obtain an SOA from both Mr. and Mrs. Nelson. Which of the following describes Permission to Contact guidelines? Correct Answer/s- It is method specific (e.g., telephone, email), short term (i.e., expires when contact is made), and event specific (i.e., limited to the products identified).

Whose email address may the agent enter into the LEAN enrollment application? Correct Answer/s- Only the consumer's (or leave it blank) Agent Kim is conducting an event that has been advertised as educational. Which activities are permitted at an educational event? Correct Answer/s- the one with scope of appointments in the answer What is the definition of Waste? Correct Answer/s- NOT***** Waste includes any practice that results in the provision of services that are not medically necessary. Which of the issues below are examples of Fraud, Waste and/or Abuse? (Select 3) Correct Answer/s- - Falsifying signatures or medical records.

• The pharmacy splits the original prescription to receive additional dispensing fees.
• Using another person's medical insurance information to obtain prescriptions. Which of the following materials is an agent NOT permitted to display and/or distribute at a marketing/sales event? Correct Answer/s- 5 - dollar gift cards to an in-network pharmacy. Rina, a consumer, has requested an appointment with Connor, an agent, to discuss DSNPs. Prior to the appointment Rina completed a Scope of Appointment (SOA) form. On the day of the appointment, Rina brings her friend Shelley, who is Medicare-eligible, to the meeting. Shelley also wants to talk about DSNPs. What should Connor do when he sees both Rina and Shelley at the appointment? Correct Answer/s- Ask Shelley to complete an SOA before the start of the meeting. Agent Bryan wants to grow his book of business. Which of the following lead generating activities is NOT compliant? Correct Answer/s- At each appointment he asks the consumer for the name and phone number of at least one acquaintance who is 65 or older and calls the referred individual. By signing the Statement of Understanding, the consumer: Correct Answer/s- Acknowledges that they clearly understand that they are enrolling in a plan, combined with knowing the specific plan in which they are enrolling. 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? Correct Answer/s- Leave any field requesting a consumer email address blank.