PMHNP Boards Questions with 100% Correct Answers.

Medicare Part A Coverage Correct Answer 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 Correct Answer >65 in social security automatic enrollment Medicare Part A Cost Correct Answer No cost if automatically qualified. 30-39 work quarters: ~$250/mo <30 work quarters: ~$450/mo Medicare Part B Coverage Correct Answer Supplemental medical insurance. Outpatient services, care, physical/speech therapy, some home health care, medical equipment Medicare Part B Eligibility Correct Answer Voluntary if >65 Medicare Part B Cost Correct Answer Deducted from monthly social security check. *Enroll 3 months before 65th birthday or 4 months after, otherwise increased costs to enroll* Medicare Part C Correct Answer Medicare Advantage. Get all their medical services through that plan. Medicare Part D coverage Correct Answer Prescription drug coverage Medicare Part D Cost Correct Answer Varies depending on how extensive drug benefit is. Different plans have different benefits. Medigap Plans Correct Answer Fill gaps in coverage that occur with Medicare Medicare Advantage Plan Correct Answer Will likely eliminate need for medigap insurance? Medicaid Eligibility Correct Answer 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 Correct Answer Federal + state. States determine how much they want to pay in, different states have different qualities of Medicaid HMO Correct Answer Four components: Enrolled population, prepayment of premiums, coverage of comprehensive medical svcs, centralization of medical and hospital svcs Closed-panel HMO Correct Answer 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 Correct Answer Network HMO, Individual Practice Association, Point of Service Plans Network HMO Correct Answer HMO contracts with more than one group of practices Individual Practice Association Correct Answer Insurance coverage. Contract with an association of physicians to provide services to members Point of Service (POS) and Preferred Provider Organizations (PPOs) Correct Answer Insurance 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 discount