Some services provided by your health plan may be limited to a defined service area. If you move out of the service area for some Medicare plans, you will automatically be disqualified from that plan.
Silver Sneakers is a fitness program for seniors that includes access to gyms all across the country, and various other fitness classes. Original Medicare does not include Silver Sneakers benefits, but many Medicare Advantage plans do provide free Silver Sneakers memberships to their enrollees.
Skilled nursing care is care provided by a registered nurse or a licensed practical nurse and which may be provided in a skilled nursing facility or in the patient’s home. Skilled nursing care is often necessary as a patient rehabilitates from an illness or injury, but the care provided is above and beyond that which can be provided by certified nursing assistants (CNAs) or home health aides.
Skilled nursing care can be covered by Medicare, Medicare, or other health plans. Original Medicare will only cover a stay in a skilled nursing facility (including the skilled nursing care that’s provided during the stay) if the patient has at least a three-night inpatient (not observation) stay in the hospital prior to the stay in the skilled nursing facility.
A skilled nursing facility provides the staff and equipment to administer skilled nursing care, rehabilitation services or other health care services.
Original Medicare will pay for a stay in a skilled nursing facility if the enrollee was admitted as a hospital inpatient for at least three nights prior to the stay in the skilled nursing facility (a subsequent skilled nursing facility claim can be covered without another hospital stay, as long as it occurs within 30 days of the first skilled nursing facility stay).
A social health maintenance organization is a health care insurance plan offering a complete range of coverage and benefits, including: personal care services, hearing aids, dental care, eyeglasses, prescription drug and chronic care benefits, short-term nursing home care and medical transportation services. An SHMO is more expensive, but enrollees are covered for far more services than Original Medicare.
A special election period, also known as a special enrollment period, is a time period during which Medicare beneficiaries can change their Medicare Advantage or Part D coverage outside of the normal annual open enrollment period and after their initial enrollment period has ended.
A special election period will be triggered by a qualifying event, which can include a move from the area covered by a recipient’s existing Medicare plan, loss of other coverage, a violation of policy terms by a plan provider or other reasons approved by the Centers for Medicare and Medicaid Services.
If you missed your first opportunity to sign up for Medicare Part B because you were still working (or your spouse was) at age 65 and were covered by an employer group health plan at that time, an eight-month special enrollment period begins the month after your job ends, or when your previous group health coverage ends – whichever happens first.
A Medicare special needs plan (SNP) is a type of Medicare Advantage plan that provides all of the health care and services of Medicare Parts A and B to people who require special care for chronic illnesses, care management of multiple diseases, and focused care management. The plans may be limited to individuals in specific types of institutions – such as nursing homes – or beneficiaries who are dual eligibles or who have specific chronic or disabling conditions.
Specified Low-Income Medicare Beneficiaries (SLMB) is a Medicaid program that will cover your Medicare Part B premiums if you have limited resources, an income below the poverty line, and are already receiving Medicare Part A.
The SLMB program is one of the four types of Medicare Savings Programs that help Medicare beneficiaries with limited income and assets afford health care. The eligibility rules and benefits are different for each of the Medicare Savings Programs. A single person can qualify for the SLMB program in 2018 with an income up to $1,234 per month ($1,666/month for a couple).
People who qualify as an SLMB do not have to pay the Medicare Part B premium themselves, as Medicaid pays it instead. And these beneficiaries are also automatically eligible for Extra Help paying for Part D prescription coverage.
State Health Insurance Assistance Programs (SHIPs) are federally funded programs in each state and in some territories that provide free counseling and assistance to Medicare enrollees and their families.
SHIPs are not affiliated with insurance companies, so they can provide unbiased advice and assistance. They can answer questions and provide advice about benefits, premiums, cost-sharing, enrollment windows, and appeals. They can also assist you with the process of enrolling in, or disenrolling from, a Medicare Advantage plan or a Medicare Part D plan.
You can find your state’s SHIP here.
Through its state medical assistance office, each state provides services – including Medicaid – and helpful information to low-income citizens.