NUR 212 NEWEST EXAM COMPLETE WITH
DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
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.
Health Law Creation - ANSWER-Federal Statutes dominate
Arises from authority to "tax and spend" and "regulate interstate commerce"
(Article 1 of the US Constitution)
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.
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.
What does Medicaid cover? - ANSWER-Hospital
MD visits
Rx
Vision
Dental
Home health
Nursing home care (60% of this population receive Medicaid benefits)
Children's Health - ANSWER-Children's Health Insurance Program (CHIP).
Covers about 8 million children who do not qualify for Medicaid.
Jointly funded by Federal and State governments.
Coverage similar to Medicaid.
Costs capped at 5% of family income.
Patient Protection and Affordable Care Act (ACA) - ANSWER-Passed into law in
2010.
Most provisions in effect by 2014.
ACA Provisions - ANSWER-Individual mandate - all individuals must purchase
health insurance or pay penalty (with exceptions for religion or financial hardship).
Businesses with more than 50 employees must offer health insurance or pay
penalty.
Small businesses receive tax credits for offering health insurance to employees.
, ACA Court Challenges - ANSWER-Constitutionality of law challenged by an
independent business group.
Supreme Court heard case in 2012.
Upheld most elements of law, including individual mandate.
King v Burwell (2015) - challenged subsidies in states that use federal exchange.
SCOTUS did strike down this important provision... - ANSWER-Mandated
Medicaid expansion by states.
States opting out of expansion will have residents in an insurance "gap" comprised
of non-disabled, non-elderly adults under 138% FPL but over state Medicaid
threshold.
Changes in coverage under ACA - ANSWER-In 2012, about 50 million Americans
uninsured.
By 2015, down to about 30 million.
By 2019, that number may be down to 25 million.
The latest tax bill brings this estimate into question
Changes under ACA - ANSWER-Childless, non-disabled adults easier access to
health care.
As of 2014, Medicaid reimbursement on par with Medicare.
No lifetime coverage limits.
No pre-existing condition denials.
No pre-existing condition cancellations.
May stay on parents’ policy until 26 yrs old.
Individual Mandate Tax Penalty - ANSWER-2017 = $695 per person and $347.50
per child per year | or 2.5% of your income
In December of 2017, President Trump signed a tax bill that repeals the individual
mandate penalty.
Doesn't go into effect until 2019...
Will likely cause a decrease in insurance enrollment
Who else lacks health insurance? - ANSWER-Answer: Mostly, those who can't
afford it. 16% of non-elderly population.
Why does that matter?
DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
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.
Health Law Creation - ANSWER-Federal Statutes dominate
Arises from authority to "tax and spend" and "regulate interstate commerce"
(Article 1 of the US Constitution)
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.
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.
What does Medicaid cover? - ANSWER-Hospital
MD visits
Rx
Vision
Dental
Home health
Nursing home care (60% of this population receive Medicaid benefits)
Children's Health - ANSWER-Children's Health Insurance Program (CHIP).
Covers about 8 million children who do not qualify for Medicaid.
Jointly funded by Federal and State governments.
Coverage similar to Medicaid.
Costs capped at 5% of family income.
Patient Protection and Affordable Care Act (ACA) - ANSWER-Passed into law in
2010.
Most provisions in effect by 2014.
ACA Provisions - ANSWER-Individual mandate - all individuals must purchase
health insurance or pay penalty (with exceptions for religion or financial hardship).
Businesses with more than 50 employees must offer health insurance or pay
penalty.
Small businesses receive tax credits for offering health insurance to employees.
, ACA Court Challenges - ANSWER-Constitutionality of law challenged by an
independent business group.
Supreme Court heard case in 2012.
Upheld most elements of law, including individual mandate.
King v Burwell (2015) - challenged subsidies in states that use federal exchange.
SCOTUS did strike down this important provision... - ANSWER-Mandated
Medicaid expansion by states.
States opting out of expansion will have residents in an insurance "gap" comprised
of non-disabled, non-elderly adults under 138% FPL but over state Medicaid
threshold.
Changes in coverage under ACA - ANSWER-In 2012, about 50 million Americans
uninsured.
By 2015, down to about 30 million.
By 2019, that number may be down to 25 million.
The latest tax bill brings this estimate into question
Changes under ACA - ANSWER-Childless, non-disabled adults easier access to
health care.
As of 2014, Medicaid reimbursement on par with Medicare.
No lifetime coverage limits.
No pre-existing condition denials.
No pre-existing condition cancellations.
May stay on parents’ policy until 26 yrs old.
Individual Mandate Tax Penalty - ANSWER-2017 = $695 per person and $347.50
per child per year | or 2.5% of your income
In December of 2017, President Trump signed a tax bill that repeals the individual
mandate penalty.
Doesn't go into effect until 2019...
Will likely cause a decrease in insurance enrollment
Who else lacks health insurance? - ANSWER-Answer: Mostly, those who can't
afford it. 16% of non-elderly population.
Why does that matter?
