PMHNP Boards
1. 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.
2. Medicare Part A Eligibility: >65 in social security automatic enrollment
3. Medicare Part A Cost: No cost if automatically qualified. 30-39 wor
quarters:
~$250/mo <30 work quarters: ~$450/mo
4. Medicare Part B Coverage: Supplemental medical insurance.
Outpatient ser- vices, care, physical/speech therapy, some home
health care, medical equipment
5. Medicare Part B Eligibility: Voluntary if >65
6. 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*
7. Medicare Part C: Medicare Advantage. Get all their medical services
through that plan.
8. Medicare Part D coverage: Prescription drug coverage
9. Medicare Part D Cost: Varies depending on how extensive drug
benefit is. Different plans have different benefits.
10.Medigap Plans: Fill gaps in coverage that occur with Medicare
11.Medicare Advantage Plan: Will likely eliminate need for medigap
insurance?
12.Medicaid Eligibility: Automatic coverage not guaranteed except for
poor preg- nant 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.
13.Medicaid funding: Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
,14.HMO: Four components: Enrolled population, prepayment of
premiums, cover- age of comprehensive medical svcs, centralization of
medical and hospital svcs
15.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.
16.Open-panel HMO: Network HMO, Individual Practice Association, Point
of Ser- vice Plans
17.Network HMO: HMO contracts with more than one group of practices
18.Individual Practice Association: Insurance coverage. Contract with an
asso- ciation of physicians to provide services to members
19.Point of Service (POS) and Preferred Provider Organizations (PPOs):
Insur- ance coverage. Patients allowed to self-refer to specialist but pay
higher premium to do so. POS requires PCP is gatekeeper but pt can see
a provider outside of HMO for more $$. PPOs contract to a selected
, group of participating providers and give
1. 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.
2. Medicare Part A Eligibility: >65 in social security automatic enrollment
3. Medicare Part A Cost: No cost if automatically qualified. 30-39 wor
quarters:
~$250/mo <30 work quarters: ~$450/mo
4. Medicare Part B Coverage: Supplemental medical insurance.
Outpatient ser- vices, care, physical/speech therapy, some home
health care, medical equipment
5. Medicare Part B Eligibility: Voluntary if >65
6. 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*
7. Medicare Part C: Medicare Advantage. Get all their medical services
through that plan.
8. Medicare Part D coverage: Prescription drug coverage
9. Medicare Part D Cost: Varies depending on how extensive drug
benefit is. Different plans have different benefits.
10.Medigap Plans: Fill gaps in coverage that occur with Medicare
11.Medicare Advantage Plan: Will likely eliminate need for medigap
insurance?
12.Medicaid Eligibility: Automatic coverage not guaranteed except for
poor preg- nant 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.
13.Medicaid funding: Federal + state. States determine how much they
want to pay in, different states have different qualities of Medicaid
,14.HMO: Four components: Enrolled population, prepayment of
premiums, cover- age of comprehensive medical svcs, centralization of
medical and hospital svcs
15.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.
16.Open-panel HMO: Network HMO, Individual Practice Association, Point
of Ser- vice Plans
17.Network HMO: HMO contracts with more than one group of practices
18.Individual Practice Association: Insurance coverage. Contract with an
asso- ciation of physicians to provide services to members
19.Point of Service (POS) and Preferred Provider Organizations (PPOs):
Insur- ance coverage. Patients allowed to self-refer to specialist but pay
higher premium to do so. POS requires PCP is gatekeeper but pt can see
a provider outside of HMO for more $$. PPOs contract to a selected
, group of participating providers and give
