DIMENSIONS OF NURSING PRACTICE FINAL
2026 EXAM PREP STUDY GUIDE
COMPREHENSIVE SOLUTIONS
◉ Entitlement. Answer: a type of financial help provided by the
government for members of a particular group
◉ Medicare and Medicaid. Answer: Two very large entitlement
programs that provide health care and services.
Combined they serve more than one third of the US population.
Medicare - 60 million beneficiaries
Medicaid - 70 million beneficiaries.
◉ Medicare. Answer: Federal social insurance program.
Managed by Centers for Medicare and Medicaid Services (CMS).
Anyone 65 years or older is eligible.
On SSDI > 24 months.
ESRD patients who have been on dialysis for three months. (added
by Nixon)
Those with ALS
◉ Paying for Medicare. Answer: 40 %from general fund.
,Rest from Medicare taxes, premiums, deductibles, SS taxes, etc...
◉ Medicare Part A. Answer: No premium for most.
Covers hospital stays and short term rehab (after $1300 deductible).
Covers some home health.
Covers 100% of hospice care including meds, staff, equipment in
hospice
Will pay first 90 days of a hospital stay. Co-pay of about $300/day
after day 60.
Also offers 60 "lifetime reserve" days beyond the 90. Co-pay of about
$600/day for these.
◉ Medicare Part B. Answer: Premium-based (most pay about
$100/month).
Covers MD visits.
Preventive care.
Durable medical equipment (walker, shower chair, ect.)
Ambulance service.
$183 annual deductible then Medicare pays 80%, patient pays 20%
◉ Medicare Part C. Answer: AKA Medicare Advantage
,Basically, a highly regulated but private replacement for Parts A and
B.
Coverage and premiums vary.
Not generally something lower income patients enroll in due to costs
◉ Medicare Part D. Answer: Large expansion of Medicare passed in
2003 under President Bush.
Prescription drug plan. Cost estimate $92 billion in 2018
$400 annual deductible.
Avg ̴$40/mo premium. Varies with plan, income.
Pays 75% of drug costs, up to $2970 per year (now $3700 per year).
Then nothing until costs reaches $4750 at which point Medicare
pays 95%.
Donut Hole (the hole between what Medicare D will pay for and
what the pt has to pay for)
ACA trying to close that hole by raising the amount Medicare D will
pay
◉ Medicaid. Answer: Federal health insurance program for certain
low-income and disabled individuals.
Funded jointly by federal and state governments (50-80% federal).
Managed by states.
Eligibility largely determined at state level.
, 25% of all children covered by Medicaid.
50% of all Medicaid recipients are children.
Account for only 20% of cost.
◉ Medicaid Eligibility. Answer: Highly Variable
For adults, usually based on % of FPL (federal poverty level)
FPL is $12K for one adult. $20K for family of 3.
Examples:
AL - Parents - 18%; Childless adults - 0%.
32 states expanded Medicaid thru ACA, 138% for parents and
childless adults.
NC - Parents - 44%; Childless adults - 0%.
◉ Who is eligible?. Answer: Those with low a income and are:
Children
Pregnant
Adult with dependent children
Disabled
Blind
States may apply to CMS to expand coverage to other groups. Some
do, some don't.
2026 EXAM PREP STUDY GUIDE
COMPREHENSIVE SOLUTIONS
◉ Entitlement. Answer: a type of financial help provided by the
government for members of a particular group
◉ Medicare and Medicaid. Answer: Two very large entitlement
programs that provide health care and services.
Combined they serve more than one third of the US population.
Medicare - 60 million beneficiaries
Medicaid - 70 million beneficiaries.
◉ Medicare. Answer: Federal social insurance program.
Managed by Centers for Medicare and Medicaid Services (CMS).
Anyone 65 years or older is eligible.
On SSDI > 24 months.
ESRD patients who have been on dialysis for three months. (added
by Nixon)
Those with ALS
◉ Paying for Medicare. Answer: 40 %from general fund.
,Rest from Medicare taxes, premiums, deductibles, SS taxes, etc...
◉ Medicare Part A. Answer: No premium for most.
Covers hospital stays and short term rehab (after $1300 deductible).
Covers some home health.
Covers 100% of hospice care including meds, staff, equipment in
hospice
Will pay first 90 days of a hospital stay. Co-pay of about $300/day
after day 60.
Also offers 60 "lifetime reserve" days beyond the 90. Co-pay of about
$600/day for these.
◉ Medicare Part B. Answer: Premium-based (most pay about
$100/month).
Covers MD visits.
Preventive care.
Durable medical equipment (walker, shower chair, ect.)
Ambulance service.
$183 annual deductible then Medicare pays 80%, patient pays 20%
◉ Medicare Part C. Answer: AKA Medicare Advantage
,Basically, a highly regulated but private replacement for Parts A and
B.
Coverage and premiums vary.
Not generally something lower income patients enroll in due to costs
◉ Medicare Part D. Answer: Large expansion of Medicare passed in
2003 under President Bush.
Prescription drug plan. Cost estimate $92 billion in 2018
$400 annual deductible.
Avg ̴$40/mo premium. Varies with plan, income.
Pays 75% of drug costs, up to $2970 per year (now $3700 per year).
Then nothing until costs reaches $4750 at which point Medicare
pays 95%.
Donut Hole (the hole between what Medicare D will pay for and
what the pt has to pay for)
ACA trying to close that hole by raising the amount Medicare D will
pay
◉ Medicaid. Answer: Federal health insurance program for certain
low-income and disabled individuals.
Funded jointly by federal and state governments (50-80% federal).
Managed by states.
Eligibility largely determined at state level.
, 25% of all children covered by Medicaid.
50% of all Medicaid recipients are children.
Account for only 20% of cost.
◉ Medicaid Eligibility. Answer: Highly Variable
For adults, usually based on % of FPL (federal poverty level)
FPL is $12K for one adult. $20K for family of 3.
Examples:
AL - Parents - 18%; Childless adults - 0%.
32 states expanded Medicaid thru ACA, 138% for parents and
childless adults.
NC - Parents - 44%; Childless adults - 0%.
◉ Who is eligible?. Answer: Those with low a income and are:
Children
Pregnant
Adult with dependent children
Disabled
Blind
States may apply to CMS to expand coverage to other groups. Some
do, some don't.
