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MMA 2003

Glossary

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.

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Term Definition
SB CROSSWALK

The SB Crosswalk document is available from the PBP HELP menu and provides a detailed explanation of how each SB sentence is derived from the PBP variables.

SCREENS

A screen is an area beneath the tab where variables are presented. A tab represents a screen. The variables on the screen are displayed by selecting a tab. A tab may contain one or more sub tabs.

SECOND OPINION

This is when another doctor gives his or her view about what you have and how it should be treated.

SECONDARY PAYER

An insurance policy, plan, or program that pays second on a claim for medical care. This could be Medicare, Medicaid, or other health insurance depending on the situation.

SERVICE AREA

The area where a health plan accepts members. For plans that require you to use their doctors and hospitals, it is also the area where services are provided. The plan may disemroll you if you move out of the plan's service area.

SERVICE AREA (PRIVATE FEE-FOR-SERVICE)

The area where a Medicare Private Fee-for-Service plan accepts members.

SERVICE CATEGORY DEFINITION

A general description of the types of services provided under the service and/or the characteristics that define the service category.

SIDE EFFECT

A problem caused by treatment. For example, medicine you take for high blood pressure may make you feel sleepy. Most treatments have side effects.

SKILLED CARE

A type of health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care.

SKILLED NURSING CARE*

A level of care that must be given or supervised by Registered Nurses. All of your needs are taken care of with this type of service. Examples of skilled nursing care are: getting intravenous injections, tube feeding, oxygen to help you breathe, and changing sterile dressings on a wound. Any service that could be safely done by an average non-medical person (or one's self) without the supervision of a Registered Nurse is not considered skilled care.

SKILLED NURSING FACILITY (SNF)

A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.

SOCIAL HEALTH MAINTENANCE ORGANIZATION (SHMO)

A special type of health plan that provides the full range of Medicare benefits offered by standard Medicare HMOs, plus other services that include the following: prescription drug and chronic care benefits, respite care, and short-term nursing home care; homemaker, personal care services, and medical transportation; eyeglasses, hearing aids, and dental benefits.

SPECIAL ELECTION PERIOD

A set time that a beneficiary can change health plans or return to the Original Medicare Plan, such as: you move outside the service area, your Medicare+Choice organization violates its contract with you, the organization does not renew its contract with CMS, or other exceptional conditions determined by CMS. The Special Election Period is different from the Special Enrollment Period (SEP). (See Election Periods; Enrollment; Special Enrollment Period (SEP).)

SPECIAL ENROLLMENT PERIOD (SEP)

A set time when you can sign up for Medicare Part B if you did not take Part B during the Initial Enrollment Period, because you or your spouse currently work and have group health plan coverage through the employer or union. You can sign up at any time you are covered under the group plan. If the employment or group health coverage ends, you have 8 months to sign up.The 8-month SEP starts the month after the employment ends or the group health coverage ends, whichever comes first. The Special Enrollment Period is different from the Special Election Period. (See Enrollment; Election Periods; Special Election Period.)

SPECIALIST

A doctor who treats only certain parts of the body, certain health problems, or certain age groups. For example, some doctors treat only heart problems.

SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLMB)

A Medicaid program that pays for Medicare Part B premiums for individuals who have Medicare Part A, a low monthly income, and limited resources.

STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP)

A state program that gets money from the federal government to give free health insurance counseling and assistance to people with Medicare.

STATE INSURANCE DEPARTMENT

A state agency that regulates insurance and can provide information about Medigap policies and any insurance-related problem.

STATE MEDICAL ASSISTANCE OFFICE

A state agency that is in charge of the State's Medicaid program and can provide information about programs to help pay medical bills for people with low incomes. Also provides help with prescription drug coverage.

STEP-UP BENEFITS

Benefit Offerings are considered step-up benefits if a plan benefit package includes one of the following benefit structures in a particular service category: 1) more than one optional supplemental benefit; 2) both a mandatory and optional benefit; or 3) both an additional and optional benefit. For example, a plan may offer three prescription drug optional supplemental benefits, which offer varying levels of drug coverage; in this case, two of the optional benefit offerings would be considered step-up benefits. Alternatively, a plan may offer prescription drug benefits as either an additional or mandatory benefit and then an optional benefit; in this case, the optional benefit would be considered a step-up benefit.

SUB SCREENS

A sub screen is an area beneath the sub tab where variables are presented. A sub tab represents a sub screen. The variables on the sub screen are displayed by selecting a sub tab.

SUBSIDIZED SENIOR HOUSING

A type of program, available through the Federal Department of Housing and Urban Development and some States, to help people with low or moderate incomes pay for housing.

SUPER USER

A Super User is the user who defined the plans in HPMS and downloaded from the HPMS Web site.

SUPPLIER

Generally, any company, person, or agency that gives you a medical item or service, like a wheelchair or walker.

*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.
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Date Last Updated: September 23, 2004

 

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