COMPLETE NUR 303 EXAM 2025 STUDY GUIDE – QUESTIONS AND VERIFIED SOLUTIONS

1. Subsidies - ANSWER The government covers remaining cost of monthly premium for those who qualify. The amount the government pays in known as 2. Tax credit - ANSWER For those with incomes that do not allow medic aid coverage, ________ __________ assist in the payment of health insurance. Receiving credit now lowers out of pocket premium costs as receiving coverage later allows you to claim the credit through filing taxes. 3. Metal insurance plans - ANSWER health plans that are grouped by levels of coverage, they vary by the percentage of costs you have to pay on average toward the health care you receive Bronze Silver Gold Platinum - ANSWER percentage costs you pay for each plan: 40% 30% 20% 10% (ex: insurance pays 90%) 4. Welcome to Medicare Visit - ANSWER Following the visit, your doctor will give you a plan or checklist with free screenings and preventive services that you need 5. Patient protection affordability care act (PPACA) requirements - ANSWER identifies specific responsibilities on hospitals w/ regard to the health of the community -conduct community health needs assessment -broad base of representation from the community -apply financial arraignments EQUITABLY -clear charity care policies, available to the public 6. PPACA - ANSWER -Its primary goal is to reduce the number of uninsured Americans by reducing healthcare costs -is expanding access to preventative care via community benefit programs and wellness activities -hospitals are to help local health departments meet accreditation board requirements 7. Preventative care requirements - ANSWER -expanding access to preventive care -public health -community benefit programs -evidence based -no longer unilateral choices of "activities" -hospitals to help local health departments meet accreditation board requirement -disease self management -risk reduction -enable patient responsibility& accountability -wellness activities 8. how the PPACA affects cost, quality and access - ANSWER cost- allowing tax credits to lower premiums and make it more affordable. quality-reimbursing physicians on the quality of their care. access- no one can be denied health insurance anymore due to preexisting conditions. 9. Universal healthcare - ANSWER -Coverages continues in the private sector with gov subsidies (CMS) -Cannot be turned down for coverage , regardless of pre-existing condition -Lift the 1million lifetime cap on coverage 10. Dependent coverage - ANSWER Covers dependent up to age 26 regardless if they are: - Still school - Married or single - Living somewhere else 11. fee-for-service pay-for-performance shared savings prospectively paid bundles capitation - ANSWER 5 reimbursement models 12. Pay-for-performance - ANSWER reimburses providers and facilities based on measures of clinical quality, safety, efficiency, and patient satisfaction 13. medical home - ANSWER a model for comprehensive and coordinated outpatient care 14. Health insurance risk pool - ANSWER special programs created by state legislatures to provide a safety net for the "medically uninsurable" 15. medically uninsurable - ANSWER people who have, in the past, been denied insurance due to preexisting conditions, or who can only access private coverage that's restricted or has very high rates 16. individual mandate - ANSWER every resident must obtain minimum level insurance 17. Guaranteed issue - ANSWER Nobody can be turned away from medical coverage regardless of age, gender, or physical health including preexisting conditions. 18. Health insurance exchanges (HIE) - ANSWER a health insurance "mall" that allows customers to compare costs of plans 19. Massachusetts health connector - ANSWER A health insurance marketplace that manages several coverage programs. It allows opportunities to go out and shop for insurance plans 20. high risk pool plans - ANSWER offer health insurance coverage that is subsidized by a state government. Typically, your premium is up to twice as much as you would pay for individual coverage if you were healthy. 21. Minimum essential coverage - ANSWER The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage 22. Donut hole - ANSWER The original strategic plan for Medicare D was to introduce some basic prescription drug coverage. It was politically very popular until the details were explained. 0-$2,250 is covered by part D $2,250-$5,100 not covered $5,100+ 95% covered 23. Accountable care organization (ACO) - ANSWER are groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. 24. Capitation - ANSWER a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services 25. Capitation payments - ANSWER -are currently used by MCO's to control health care costs -control use of health care resources by putting the physician at financial risk for services provided to patients 26. Fee-for-service model - ANSWER -rewards healthcare for using more services -no check and balances on expenditures -is NOT a market based fee system 27. Comparative effectiveness research - ANSWER compares treatments to determine the best "value" based on clinical evidence of effectiveness in relation to cost. 28. Independent payment advisory board (IPAB) - ANSWER -oversee medicare spending -independent nonpartisan group -presidential appointment -senate approval -5 year terms -recommendation on how to improve medicare for beneficiaries 29. 8% rule - ANSWER If insurance costs less than _% of your income you have to buy it, and if you don't you will face tax penalties. If insurance costs more than _% of your income you are exempt from buying it 30. Small business health options programs (SHOP) - ANSWER PPACA created _____ as a part of each state's Health Insurance Marketplace, where small-businesses with under 50 full-time equivalent employees can shop for group health plans. -in 2016, those with 100 full-time equivalent employees can use the SHOP 31. National Physician Payment Transparency Program (NPPTP) --> sunshine law - ANSWER Open Payments from the ACA. Tell patients and healthcare consumers what you are charging for services. 32. Sunshine law - ANSWER Its purpose is to create greater transparency in the health care market, particlulary by increasing the public awareness of financial relationships between medical manufactures and health care providers 33. Physician (AMA) reaction to ruling - ANSWER protested that the policy could violate the privacy rights of doctors and patients 34. Indemnify - ANSWER to make whole again 35. Insurance - ANSWER the equitable transfer of the risk of a loss, from one entity to another in exchange for payment 36. private insurance coverage - ANSWER Includes Not for Profit and For Profit and funded/payed by CMS, Self-Pay, and Private Insurance 37. government healthcare (public insurance) - ANSWER Run and funded by government. VA, Military, Indian Health Services are examples. 38. young invincibles - ANSWER Hard to persuade, the healthy 18-34 y/o crowd has been brought into the fold and only 6% lack insurance today. 39. government insurance - ANSWER Medicare part A 40. Medicaid - ANSWER payer of last resort