UHC Certification Questions and Answers Rated A

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UHC Certification Questions and Answers Rated 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 Medicarecovered 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 standalone 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 costsharing (copayments or coinsurance). What are these drug levels called? ✔✔Drug tiers In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following underwriting criteria apply EXCEPT: ✔✔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. ✔✔TRUE Which of the following is NOT true of Medicare Supplement Insurance Plans? ✔✔Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. NOT Which definition best describes Medicare Part A? The part of Medicare that is a voluntary program offered by private insurance companies that provides prescription drug coverage for an additional monthly premium. The part of Medicare that offers combined medical and prescription drug coverage. The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with hospice care and some skilled care for the homebound. The part of Medicare that helps with the cost of medically necessary doctor visits and other medical services, including outpatient care at hospitals and clinics, laboratory tests, some diagnostic screenings. ✔✔The part of Medicare that helps with the cost of inpatient hospital stays. It also helps with hospice care and some skilled care for the homebound. Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically disenrolled from his/her MA Plan. A member does not need a valid election period to disenroll from an MA plan. When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is not automatically disenrolled from his/her MA Plan. A consumer can use a Medicare Supplement Insurance Plan and an MA Plan at the same time. ✔✔When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically disenrolled from his/her MA Plan. Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? Medicaid Original Medicare Low Income Subsidy ✔✔Original Medicare 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 areaWhich plan is being described? Medicare Advantage Prescription Drug Medicaid Original Medicare ✔✔Medicare Ad [Show More]

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