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WELLCARE ACT MASTERY EXAM -
BROKER, QUESTIONS AND ANSWERS
UPDATED ( 2026 /2027) (VERIFIED
ANSWERS)
Which of the following is not an example of Protected Health Information (PHI)?
a. Medical records
b. Payment history
c. Library card correct answer c. Library card
Which option is the preferred method to submit enrollment?
a. Centene Workbench Upload
b. Ascend Web/Mobile Application
c. Fax/Paper correct answer b. Ascend Web/Mobile Application
With which types of inquiries can Wellcare's Corporate Sales Support team assist?
a. Application and Enrollment
b. Onboarding and Certifications
c. Commissions
d. All of these correct answer d. All of these
A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an:
a. Appeal
b. Grievance correct answer a. Appeal
The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies.
a. Sixty Thousand
b. Thirty Thousand
c. Twenty Thousand correct answer a. Sixty Thousand
With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1 / 1 / 2024 , existing members can continue to use their current ID card 1 / 1 / 2024 and beyond.
True
False correct answer False
____ Prescription Drug Plans (PDPs) will be offered across all 50 U.S. states and Washington, D.C.
a. Two
b. Three
c. Four
d. Five correct answer d. Five
Wellcare added which state to its footprint for 2024?
a. Alabama
b. Arkansas
c. Delaware
d. Oklahoma correct answer c. Delaware
b. Value Script
c. Value Plus correct answer a. Classic
*NOT b. Value Script
All Prescription Drug Plans (PDPs) will feature a $ 0 Tier 1 benefit when filled at preferred pharmacies.
True
False correct answer True
All Prescription Drug Plans (PDPs) will offer a $___ copay for most Part D preventive vaccines, regardless of which network pharmacy is used by members.
a. Zero
b. Five
c. Ten
d. Fifteen correct answer a. Zero
Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted.
True
False correct answer True
*Wellcare's _____ plan is designed for Low-Income Subsidy members.
a. Classic
b. Value Plus
c. Value Script correct answer a. Classic
*NOT c. Value Script
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums.
True
False correct answer False
Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary.
a. 1
b. 3
c. 5
d. 7 correct answer a. 1
If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed.
True
False correct answer True
Once the enrollment is completed, you can save a copy of the application for your reference.
True
False correct answer False
Members who fail to pay the required premiums before the end of the grace period (Wellcare has a three-month grace period) will be terminated.
True
a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor.
c. Not explaining the provider network is a fundamental task during the enrollment process.
d. None of these correct answer a. Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members.
b. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor.
Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing.
True
False correct answer True
A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue.
a. 30
b. 45
c. 60
d. 90 correct answer c. 60
When discussing prescription drug coverage, you should:
(Select all that apply.)
a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. correct answer a. Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits).
b. Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c. Explain formulary tiers as well as drug copayment amounts.
d. For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception.
Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
a. Speak with the investigator as quickly as possible.
b. Answer all questions honestly and completely.
c. Offer information and documents important to the investigation.
d. All of these correct answer d. All of these
Which is an example of a top beneficiary complaint that affects Star Ratings?
a. The beneficiary was enrolled in the correct plan.
b. The provider was in-network and contracted with the selected plan.
c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan.
d. The beneficiary enrolled by the enrollment deadline. correct answer c. The beneficiary did not understand that enrolling in a Wellcare plan would change their current Medicare Advantage plan.
______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier.
a. Two
b. Three
c. Four
d. Five correct answer c. Four
Members are no longer required to pay a partial deductible due to the Inflation Reduction Act.
True
False correct answer True
Which Prescription Drug Plan (PDP) product features no deductible on any tier?
a. Classic
b. Value Script
c. Value Plus correct answer c. Value Plus
Which is the Prescription Drug Plan (PDP) Preferred Mail Order network for 2024?
a. Express Scripts Pharmacy
b. CVS Caremark
c. Both A and B correct answer a. Express Scripts Pharmacy
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1 / 1 / 2024 will impact which plan(s)?
a. PDP Only
b. MAPD Only
c. Both PDP & MAPD correct answer c. Both PDP & MAPD
In the Catastrophic Coverage stage, the member will pay $___ for brand and generic drugs for the remainder of the year once their total out of pocket costs reach $ 8 , 000.
a. Three
b. Five
c. Ten
d. Zero correct answer d. Zero
Which of the Prescription Drug Plan (PDP) products is new to the 6 - tier formulary structure for 2024?
a. Classic
b. Value Script
c. Value Plus correct answer a. Classic
Wellcare has new All-Dual D-SNP products in AL, AR, FL, GA, KY, LA, MI, MS, NC, NM, OH, OK, TX, and WI.
True
False correct answer True
Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser?
a. Value Script
b. Value Plus
c. Classic correct answer c. Classic
The _________ plan is expected to have one of the lowest premiums in the country!
a. Classic
b. Value Plus
When verifying a D-SNP beneficiary's Medicaid eligibility through the Ascend Medicaid search tool, you should confirm their current Medicaid status qualifies for the selected D-SNP being enrolled in and explain that changes in Medicaid eligiblity may affect enrollment and/or cost sharing.
True
False correct answer True
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver?
a. Member Service
b. Reputation
c. Member Payments
d. Serving Government Customers correct answer c. Member Payments
Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods?
a. Ascend
b. Telephonic
c. Paper
d. All of these correct answer d. All of these
Brokers/Agents can submit a support ticket online through their Centene Workbench portal.
True
False correct answer True
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period.
True
False correct answer True
*From October 1 to October 14 , certain activities are Non-Permissible Activities. These include:
a. Assist with completing an application
b. Collect a completed application
c. Advise the beneficiary to complete an application prior to October 15.
d. All of these correct answer d. All of these
*NOT a. Assist with completing an application
Ascend is a fast, easy, and compliant way for brokers/agents to submit agent- assisted electronic enrollments.
True
False correct answer True
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud.
True
False correct answer False
The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA).
True
False correct answer True
From October 1 to October 14 , certain activities are Non-Permissible Activities. These include: correct answer All of these
A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. correct answer False
A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse n Determination (Medicare) is a/an: correct answer Appeal
An SEP is a period outside of the ICEP, ARP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period? correct answer True
Communication of PHI can be: (Select all that apply.) correct answer Written, Electronic, and Verbal
The online Centene Workbench self-service portal enables you to: correct answer All of these
If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct timeframe for the member based on their eligibility date or change date needed. correct answer True
Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the _____ calendar quarters only. (Select all that apply.) correct answer First, Second, and Third
Brokers/agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) correct answer Complaint Tracking Module (CTM), Grievance, and Secret Shop Finding
Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: correct answer All of these
Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. correct answer True
Enrollment applications must be received by Wellcare no later than _____ calendar day(s) following receipt from the beneficiary. correct answer One (1)
Which elements are available as part of Wellcare's Sales Support model? correct answer All of these
When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. correct answer True
For Prescription Drug Plan (PDP)Medication Home Delivery, the _____ plan will continue to offer a discount ( 2. 5 x 30 - day preferred retail copay) for Tier 2 , 3 , and 6 prescriptions. correct answer Value Plus
Which Prescription Drug Plan (PDP) product features no deductible on any tier? correct answer Value Plus
Which of the Prescription Drug Plan (PDP) product is new to the 6 - tier formulary structure for 2024? correct answer Classic
Which elements are available as part of Wellcare's Sales Support model? correct answer All of these
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums correct answer False
Prior to completing the enrollment form, broker/agents should always confirm the beneficiary's primary care provider (PCP) and/or specialists correct answer True
At the end of this course, there will be a Mastery Exam. Agents must achieve a passing score of 85 % or higher to successfully complete this course correct answer True
Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a correct answer Complaint Tracking Module (CTM)
Grievance
Secret Shop Finding
A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. correct answer False
Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formaland informal). correct answer False
Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. correct answer True
CustomPoint sales material order dates will be posted on Wellcare.com correct answer False
The online Centene Workbench self-service portal enables you to correct answer All of these
The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be: correct answer Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO.
Verbally conveyed within the first minute of a sales call.
Prominently displayed on TPMO websites (regardless of content).
Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content).
Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. correct answer All of these
Which of the following is not an example of Protected Health Information (PHI)? correct answer Library Card
When a paper SOA form is used, it must be completed __________ hosting the sales presentation. correct answer 48 Hours prior to
Ascend is a fast, easy, and compliant way for brokers/agents to submit agent- assisted electronic enrollments. correct answer True
