UHC certification Questions & Answers

UHC certification Questions & Answers
1. Medicare - ANS-Federal health insurance program
2. Medicare is administered by whom? - ANS-CMS ( Centers for medicare and medicaid services)
3. Parts A & B of medicare are - ANS-federal health insurance program referred to as original
medicare
4. Part A? - ANS-Hospital insurance
5. Part B? - ANS-Medical insurance
6. What doesnt medicare cover? - ANS-routine dental, eye care hearing exam,deductibles,
coinsurance and copayments
7. Part C? - ANS-Medicare Advantage Plans
8. MA covers? - ANS-Part A &B coverage, and some part D coverage
9. MA plans are not? - ANS-Medicare supplement insurance plans
10. What offers lower monthly premiums MADP or supplement? - ANS-MADP
11. do MAP's have a annual maximum OOP maximum that limits the amount of money a member
must spend every year for covered services? - ANS-YES
12. MA plans integrate what type of additonal coverage? - ANS-part D prescription drug coverage
13. If a customer wants to keep their stand alone prescription drug plan, what may the customer
want to enroll in? - ANS-MA-only PFFS plan
14. What is a stand alone drug plan called? - ANS-PDP
15. WHat is PFFS? - ANS-Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or
hospital that accepts their terms
16. If a customer lives in a rural area, what type of plan may they want because it gives them
freedom to access doctors that may not be in their network? - ANS-PFFS plan
17. Do HMO's require referals? - ANS-Yes
18. Do PPO's require a referal? - ANS-No
19. When a member enrolls in a MA plan, they receive their coverage from medicare or the MA
plan? - ANS-MA plan
20. When a customer is enrolled in a MA plan, they must continue paying their premiums for what
other plan? - ANS-Part B
21. MA plans have a maxium annual limit on OOP costs called a? - ANS-MOOP amount ( Maxium out
of pocket)
22. When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA
plan or PDP( prescription drug plan) in which they are enrolled as of the new plans_____? - ANSeffective date
23. An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? - ANSStand alone PDP
24. If a member enrolls in a MA plan, what must the member do? - ANS-Cancel in writing their
medicare supplement insurance policy with the carrier after their request to enroll in MA plan
has been approved.
25. Medicare supplement insurance policies cannot be used in conjunction with what type of plan? -
ANS-MA plan
26. A medicare supplement insurance plan helps to cover some of the OOP costs associated with? -
ANS-original medicare.

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