NUR 212 Exam 2026 with Questions and
Answers
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.
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
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.
Answers
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.
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
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.
