Understanding Medicare Part A, Part B, and Medicare Advantage Plans, Exams of Nursing

Download Understanding Medicare Part A, Part B, and Medicare Advantage Plans and more Exams Nursing in PDF only on Docsity! Quiz 1 ahip exam 2022 / AHIP Comprehensive Solutions for Every Question Handpicked from Elite Universities 3 Broad Categories of Statistics (( 1) Descriptive, 2) Inferential and 3) Correlational and Predictive Statistics) - -correct ans- -1) Descriptive: Procedures and measures used to organize and present data in a convenient and understandable way. 2) Inferential: Procedures and measures used todraw inferences from a sample (smaller) about the population (larger) 3) Correlational and Predictive: Proceures and measures used to describe and predict the nature of relationships between at least two sets of observations. Units of Analysis (Population vs Parameter) - -correct ans- -Population: A group of phenomena that have something in common. Parameter: A summary descriptive measure of the population Sample vs Statistic - -correct ans- -Sample: Subset of the population Statistic: Summary descriptive measure of the sample. Measurement - -correct ans- -Def: The assignment of individual units of analysis in a systematic way to represent their properties. Levels of Measurement (NOIR) - -correct ans- - Nominal (Variables have mutually exclusive categories) - -correct ans- -The number assigned to each category serves ONLY to distinguish that category from others and DOES NOT have any numeric meaning or value. (i.e. sex at birth, province of residence etc.) Ordinal (Variables have rank order property and the direction of the measurement is known, i.e. who is ranked higher on the variable) - -correct ans- -Even though the order of the numeric values has meaning the distance between the values is NOT necessarily equivalent (i.e. finishing in a race, 1st, 2nd, 3rd, doesnt mean he time between them is the same) Interval (Numeric values of the variables appear at equal intervals along a measurable continuum; in other words, all adjacent value are the same distance apart) - -correct ans- - Numeric values are relative indicators of the equal distance established between each "category" along the continuum. The values have meaning only in relation to one another. (i.e. 5 or 7 point agreement scale, temp in celsius) Ratio (Numeric value of the variables appear at equal intervals along a measurable continuum that has an absolute zero) - -correct ans- -The numeric values have complete meaning, the distance between values is quantifiable and values have meaning on their own because the absolute zero serves as a benchmark (age in years) 2 Ways to Classify Variables (Continuous vs Discrete) - -correct ans- -Continuous: Variables that theoretically can take on an infinite number of values depending on how precisely we wish to measure the concept (i..e time, distance, weight) Discrete Variables: Variables that take on a finite set of values and cannot be measured any more precisely (i.e. number of children in a family) 2 Other ways to classify Variables (IV vs DV) - -correct ans- -Independent Variable: Variables identified to determine their influence on some outcome (i.e. effect of age on leisure) Dependent Variable: Variables identified to determine the influence brought upon them by some IV (i.e. the outcome) 3 Foundational Types of Descriptive Statistics - -correct ans- -Frequency Distributions (n): Frequencies and percentages Measures of Central Tendency (x): Mode, median and mean (or avg.) Median - -correct ans- -The value in a distribution of scores at which an equal number of scores are above and below it. In other words, 50% of the scores fall below the median and 50% of the scores fall above it. Mean - -correct ans- -Occasionally referred to as the arithmetic avg. the mean is the sum of all the values in a distribution divided by the number of scores in the distribution. (i.e. if there is a sample of 7, you add up all the amounts and divide by the number of cases in the sample). Common Practices - -correct ans- -1) Means are reported to 2 decimal places 2) Categories are listed in order from highest to lowest mean Measures of Variation (Range, Variance, Standard Deviation) - -correct ans- -Measures of variation describe how far away values or scores tend to be from the centre of a distribution of scores Range (Range = Xmax - Xmin) - -correct ans- -The total number of possible values over which the distribution of scores can span. (i.e. highest score in a distribution is 10 and lowest is 1, Range is 9) Limitation is that it only considers 2 scores. (i.e. if someone paid $1000 for a candy bar but the average is $2, and the lowest would be $0.5 then the range would be $999.5 Standard Deviation - -correct ans- -An indicator of the amount of variation or dispersion of scores in a distribution around the mean (and measured in the same units as the data). The higher the value of teh SD the greater the variation in the scores around the mean. Takes all of the scores into consideration Variance - -correct ans- -Just like the SD, Variance is an indicator of the amount of variation or dispersion of scores in a distribution around the mean. The higher the value of the SD the greater the variation in the distribution. Like the mean SD is reported to 2 decimal places. We cannot directly compare descriptive statistics if they are based on different units of measure (i.e. age vs height). - -correct ans- - Statistical Hypotheses (H1, vs H0) - -correct ans- -H1, The alternative or Research Hypothesis: as researchers our belief about differences among groups or the nature of relationships is based on substantive theory (i.e. previous research) There is a meaningful connection to be investigated. H0, The Null Hypothesis: As statistical analysis, our belief about differences among groups or the nature of relationships is based on probability theory. The Null Hypothesis - -correct ans- -It is used in inferential statistical testing because it postulates no difference between our sample and the population from which it has been drawn - an expectation based on probability. Statistical inference is essentially the process of drawing conclusions about unknown population parameters from known sample statistics. Testing the null hypothesis gives guidance to the researcher in deciding if the alternative/research hypothesis is supported. Types of Distribution (Empirical, Sampling, Theoretical) - -correct ans- -Empirical: - A distribution of scores based on real data. - Typically associated with a sample drawn from the population - Distribution is described using statistics Sampling: - A distribution of sample statistics Theoretical: - A distribution of an entire theoretical population of scores or an infinite number of sample statistics - Based on probability theory and described using parameters *EMPIRICAL --> SAMPLING --> THEORETICAL* Properties of Theoretical (Normal) Distribution (Symmetrical, Unimodal, Asymptotic) - -correct ans- -Symmetrical: - Same number of scores on either side of the mean Unimodal: - Mode, median, and mean are equal Asymptotic: - Tails of the distribution never touch the baseline Area Under the Theoretical (Normal) Distribution - -correct ans- -- Total area under the curve is equal to 1.0 or 100% - mean (u) is equal to zero - Standard error is equal to 1.0 - These are the critical values and represent the confidence limits - the points above and below the mean that contain 95% of all scores in the distribution. In other words there is a 0.95 probability that a score will fall within these limits. Degrees of freedom within - -correct ans- -dfw (degrees of freedom within) = n - k - variation within the groups being compared. Using same example from the top: if the sample you wanted to use was 30, then it would be: dfw = 30 - 5. Therefore the dfw would be 25. Notes - -correct ans- -When you only want to compare 2 groups use a t test, but when comparing 3 or more groups use analysis of variance or ANOVA. - ANOVA and t tests the DV needs to be a ratio and interval measure - First take a look at the p value to see if there is a significant difference, it determines the significance , and then look at the means to try and understand how different they are. Lastly, you put the t tests and chi squared numbers and stuff just as an indicator to the reader. How to write when writing up conclusions - -correct ans- -When writing up our results, we describe in words what we found and put the test statistics in parentheses as a way of providing support for our conclusions - like adding references. For example: Females report significantly lower life satisfaction than males (t = -3.257, p = .001), but they are not significantly different in overall perceived quality of life (t = -.440, p = .660). degrees of freedom (df) calculation - -correct ans- -1) Count the number of columns 2) Minus 1 3) Multiply it by the number of rows 4) Minus 1 Chi Squared - -correct ans- -- Only use the chi squared when the IV & DV are nominal and/or ordinal Parametric Tests - -correct ans- -- parametric tests use sample statistics to estimate the population parameters - they rely on assumptions and properties of theoretical distributions to draw conclusions about our empirical distributions - means are calculated so interval or ratio level measures are required for dependent variables - t-test, ANOVA, factorial ANOVA Non-Parametric Test - -correct ans- -- non-parametric tests are used when assumptions of parametric tests are not met - they are used when the focus is on the frequency distributions of scores rather than sample statistics - non-parametric tests are used when both the independent and dependent variables are nominal and/or ordinal measures • chi square Limitations of Chi Squared - -correct ans- -- the test statistic is sensitive to sample size - the larger the sample, the more likely that a statistically significant difference will result The Pearson Product-Moment Correlation Coefficient (r) - -correct ans- -- The correlation coefficient (r) measures the relationship between an independent variable (x) and a dependent variable (y), both of which are measued at the interval and/or ratio level, using 3 characteristics: 1) The direction of the relationship - is it positive (+) or negative (-)? 2) The strength of the relationship (magnitude of r) 3) The form of the relationship (correlation coefficient assumes a linear relationship) Range is from -1.0 < r < +1.0 NOTE: if the group sizes differ (i.e. "n") then the correlations cannot be compared Outliers - -correct ans- -Numbers that are much greater or much less than the other numbers in the set Heteroscedasticity - -correct ans- -the variability of the dependent variable (DV) widens or narrows as the value of the independent variable IV. Scatter plot of this is cone shaped. Skewed Distributions with scatter plot graphs - -correct ans- -- Cluster is not correlated Non-linear relationships - -correct ans- -The correlation of "r" is useless for assessing the strength of any type of relationship that is not linear (including relationships that are curvilinear). Beware, then, of interpreting the fact that "r is close to 0" as an indicator of a "weak relationship" rather than a "weak linear relationship." The Line of Best Fit/Regression Line - -correct ans- -- The line is positioned as close as possible to all of the points in the distribution. It is the regression line. - So the position of the line is determined by minimizing the total distance between the line and all of the points. - The distance between the line and each point is called the residual. The line of Best Fit Formula - -correct ans- -"y = bx + a" and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? - -correct ans- -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy? - -correct ans- -No, he cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months. Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? - -correct ans- -In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know howmuch he will have to pay. What should you tell him? - -correct ans- -Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? - -correct ans- -She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare health plan? - -correct ans- -In order to join a Medicare health plan, she must be enrolled in Parts A, B and D Mrs. Toma has a low, fixed income. What could you tell her that might be of assistance? - - correct ans- -She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the assistance could do for him if he qualifies. What could you tell him? - -correct ans- -He might qualify for help with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? - -correct ans- - Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs Mrs. Kanof is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? - -correct ans- -Medicare will cover Mrs. Kanof's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? - -correct ans- -Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. Mrs. Quigley has just turned 65 and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quigley? - -correct ans- -Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? - -correct ans- -Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? - -correct ans- -Original Medicare covers ambulance services. Mrs. Badeau wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? - -correct ans- -Medicare does not cover acupuncture, or, in general, glasses or dentures. Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him? - -correct ans- -Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him? - -correct ans- -He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern? - -correct Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network like his current HMO plan requires him to do. What should you tell him? - -correct ans- -He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? - -correct ans- -If she uses non- network providers, her doctors and hospital could decide whether to treat her on a visit-by-visit basis. Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? - -correct ans- -Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the plan's terms and conditions for payment, how will she be paid? - -correct ans- -Generally, the PFFS plan will pay Dr. Brennan directly the same amount Original Medicare would pay her. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? - -correct ans- -All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs? - -correct ans- -Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost- sharing due under Original Medicare. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him? - -correct ans- -It is always the best option to talk with his benefits administrator to see whether he needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign up for both. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Health Plan? Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her? - -correct ans- -Medicaid will coordinate benefits only with Medicaid participating providers. Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her? - -correct ans- -Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him about this situation? - -correct ans- - He could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan. Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? - - correct ans- -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? - -correct ans- -Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? - -correct ans- -Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for prescription drugs in 2017 under the standard coverage? - -correct ans- -Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist, but she doesn't think the calculations are correct because her out-of-pocket expenses would be lower than last year. She calls to ask if you can help. What might you tell her? Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums and cost sharing. How can you explain this to him? - - correct ans- -Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap. Different benefit structures Mrs. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for