NUR 2115 COMPREHENSIVE EXAM STUDY
GUIDE COMPLETE QUESTIONS AND
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
GUIDE COMPLETE QUESTIONS AND
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
