UHC Certification Actual Exam Questions and Answers 2024, Exams of Nursing

Download UHC Certification Actual Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 UHC Certification Actual Exam Questions and Answers 2024 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? - CORRECT answer Part A 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: - CORRECT answer Medicare Parts A and B Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? - CORRECT answer 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) - CORRECT answer Which of the following statements is not true about the Coverage Gap? - CORRECT answer All members reach the Coverage Gap Which of the following options are drug utilization management (UM) rules? (Select 3) - CORRECT answer 2 Which of the following best describes the Late Enrollment Penalty (LEP)? - CORRECT answer 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? - CORRECT answer 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? - CORRECT answer Drug tiers In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following underwriting criteria apply EXCEPT: - CORRECT answer Consumers may be underwritten to determine their acceptance and, if applicable, their rate. The new MACRA legislation, 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 Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. NOT 5 obtained from out-of-network providers. - CORRECT answer In most cases, they will pay the entire cost of the service if they see an out-of-network provider. Most benefits are covered out-of-network but at a higher cost. 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. - CORRECT answer 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. - CORRECT answer Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? 6 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. - CORRECT answer 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. - CORRECT answer It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. 7 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 - CORRECT answer 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. - CORRECT answer 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. 10 Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. To see a specialist, insured members must obtain referrals from a primary care physician. They can only be purchased during the Annual Election Period (AEP). - CORRECT answer - CORRECT answer The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - 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? - CORRECT answer 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.) - CORRECT answer 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) - CORRECT answer 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 11 Which is true about Medicare Supplement Open Enrollment? - CORRECT answer 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? - CORRECT answer 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? - CORRECT answer The consumer will be automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage