PMHNP BOARDS EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION

PMHNP BOARDS Medicare Part A Coverage - Hospital insurance that covers inpatient and most skilled care. Mandatory copays for hospital days 21-150, getting higher with each period of time. Medicare Part A Eligibility - 65 in social security automatic enrollment Medicare Part A Cost - No cost if automatically qualified. 30-39 work quarters: ~$250/mo 30 work quarters: ~$450/mo Medicare Part B Coverage - Supplemental medical insurance. Outpatient services, care, physical/speech therapy, some home health care, medical equipment Medicare Part B Eligibility - Voluntary if 65 Medicare Part B Cost - Deducted from monthly social security check. *Enroll 3 months before 65th birthday or 4 months after, otherwise increased costs to enroll* Medicare Part C - Medicare Advantage. Get all their medical services through that plan. Medicare Part D coverage - Prescription drug coverage Medicare Part D Cost - Varies depending on how extensive drug benefit is. Different plans have different benefits. Medigap Plans - Fill gaps in coverage that occur with Medicare Medicare Advantage Plan - Will likely eliminate need for medigap insurance? Medicaid Eligibility - Automatic coverage not guaranteed except for poor pregnant women and children. States can refuse to cover adults/head of households who lose Temporary Assistance to Needy Families d/t refusal to work. Generally covers poor people. Medicaid funding - Federal + state. States determine how much they want to pay in, different states have different qualities of Medicaid HMO - Four components: Enrolled population, prepayment of premiums, coverage of comprehensive medical svcs, centralization of medical and hospital svcs Closed-panel HMO - Specific providers identified by plan to provide the medical services to members. Staff can be salaried by HMO or an agency/group contracted by the HMO. Open-panel HMO - Network HMO, Individual Practice Association, Point of Service Plans Network HMO - HMO contracts with more than one group of practices