Interactive Glossary - Section S-U
A-C D-F G-I J-L M-O P-R S-U V-W X-Z
S
Secondary Insurance: Health insurance that covers your health care after the primary insurance on a claim for medical or hospital care. It usually pays for all or some of the costs that the primary insurer did not cover, but may not cover services not covered by the primary insurer. See also, Supplemental Insurance.
Semiprivate Room: A hospital room that contains two or more beds (generally just two), usually with a curtain separating the beds.
Service Area: The area within which a private health plan or Medicare private drug planprovides medical services to its members. In many private health plans, the area where yournetwork of providers is located.
SHIP (State Health Insurance Assistance Program): A federally-funded program in each state that answers questions about Medicare, free of charge.
Skilled Care: Medically necessary care performed by a skilled nurse or therapist. If a home health aide (someone who provides help with activities of daily living) or other person can perform the service, it is not considered skilled care. Skilled nursing includes care from Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Skilled therapy includes care from licensed physical, occupational and speech therapists.
Skilled Nursing Facility (SNF): A Medicare-approved facility that provides short-term post-hospital extended care services, at a lower level of care than provided in a hospital.
Skilled Nursing Services: Services from a registered nurse, which include administration of medications; tube feedings; catheter changes; wound care; teaching and training activities; observation and assessment of a patient's condition; and management and evaluation of a patient's plan of care.
Skilled Therapy Services: Services from licensed physical, speech/language, and occupational therapists (if originally accompanied by physical therapy or speech/language pathology services). Physical therapy services which qualify people for home health careinclude: assessment; therapeutic exercises; gait training; range of motion tests; ultrasound, shortwave, and microwave diathermy treatments; teaching services; and development, implementation, management, and evaluation of a patient plan of care. Maintenance care is covered if a physical therapist's skills are necessary for the safe and effective provision of repetitive services which use complex, sophisticated procedures.
SLMB (Specified Low-Income Medicare Beneficiary Program): Federal program administered by each state's Medicaid program that pays the Part B premium for people with Medicare with low incomes.
SNP (Special Needs Plan): A Medicare private health plan (Part C) that exclusively or primarily serves members who have a particular special need. A SNP may serve people who have both Medicare and Medicaid (dual-eligibles); people who have a specific chronic illness, like diabetes; or people who are in long-term care facilities or require an institutional level of care. Some SNPs may serve more than one type of special need.
Social Security Administration (SSA): The United States government agency responsible for advancing the economic security of Americans through shaping and managing various programs, including Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) and Extra Help.
Special Election Period: A set period of time from October 1 through December 31 of every year when you can switch to another Medicare private health plan (Part C) if your plan is closing and another one is available in your area. During this time, Medicare private plans must enroll individuals who apply whose private plans are closing.
Special Enrollment Period (SEP): A period of time outside of the general enrollment periodor open enrollment period, triggered by specific circumstances, during which you can enroll inMedicare Part B, Part D, or a private health plan (Part C). SEPs may also allow you to switch or disenroll from Part D and private health plans. In Part B, an SEP absolves you from having to pay a premium penalty. Your Part B SEP begins the month after your or your spouse’s employment or group health plan coverage ends (whichever comes first). In Part D and private health plans, you are eligible for an SEP in many situations; for example, if you were to lose any type of drug coverage that was considered creditable coverage or you were to move out of your plan’s service area. Only two Part D SEPs absolve you from the premium penalty: getting Extra Help and receiving inadequate information about the creditability of your drug coverage.
Specialist: A doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems.
Speech/Language Pathology: Therapeutic treatment of speech impairments (such as lisping and stuttering) or speech difficulties that result from illness.
Speech Therapy: See Speech/Language Pathology.
SSDI (Social Security Disability Insurance): Monthly benefits provided through the United States Social Security Administration for people who lose their ability to work because of a severe medical impairment (disability). People who receive SSDI for 24 months are eligible for Medicare.
SSI (Supplementary Security Income): Monthly benefits for people with low incomes andassets who are 65 or older, blind, or have a disability.
State Pharmaceutical Assistance Program (SPAP): State-subsidized programs that provide assistance in paying for prescription drug costs. SPAPs vary by state.
Step Therapy: A coverage restriction placed on drug coverage by private health plans andMedicare private drug plans. Before your plan will cover some (generally more expensive) drugs, you must try other (generally less expensive) drugs that treat your condition to see if they will be effective for you.
Supplemental Insurance: Fills gaps in Original Medicare coverage by helping to pay for the portion of health care expenses that Original Medicare does not pay for, such as deductiblesand coinsurances. Supplemental insurance includes Medigap plans and retiree insurancefrom a former employer. Supplemental insurance may offer additional benefits that Medicare does not cover. See also, Secondary Insurance.
Supplier: A person or business from whom you can buy medical equipment, like a walker or wheelchair. See also Provider and Durable Medical Equipment (DME).
T
Take Assignment: A term used to describe an agreement by a doctor to accept Medicare'sapproved amount for a service or item as payment in full. See also, Participating Providerand Non-Participating Provider.
Temporary First Fill: See Transition Policy.
Terminal Illness: A disease or condition that cannot be cured or adequately treated, and is expected to result in eventual death.
Therapy Caps: Limits on the amount of physical therapy, occupational therapy andspeech/language pathology that Medicare will cover in a given year.
Tiers: See Cost Tiers.
Transition Policy: Also called a “temporary first-fill.” Allows new members of Medicare private drug plans (Part D) to get temporary coverage of drugs they were taking when they joined if those medications are not covered by their new plan.
TRICARE: The Department of Defense’s health insurance program for active duty and retired military personnel and their family members. TRICARE consists of several different programs, including TRICARE for Life (TFL), a retiree benefit that acts as supplemental insurance to Medicare. TRICARE also offers coverage to reserve force members who are on active duty for 30 days or more.
TRICARE for Life: The health insurance program for military retirees who have served honorably for at least 20 years. They must be enrolled in Part B to receive the benefits. It payssecondary to Medicare and covers out-of-pocket costs including deductibles andcoinsurance. People who qualify can receive free or low-cost medications from military treatment facilities, TRICARE network and out-of-network pharmacies, and the National Mail Order Pharmacy.
U
Unearned Income: Money you get from sources other than current employment. Includes Social Security benefits, Veterans benefits, pensions, annuities and other regular payments you receive, such as alimony and workers' compensation.
Urgent Care: Immediate medical attention for a sudden illness or injury that is not life threatening.
Unskilled Care: See Personal Care.
Utilization Management Tools: See Coverage Restrictions.
Secondary Insurance: Health insurance that covers your health care after the primary insurance on a claim for medical or hospital care. It usually pays for all or some of the costs that the primary insurer did not cover, but may not cover services not covered by the primary insurer. See also, Supplemental Insurance.
Semiprivate Room: A hospital room that contains two or more beds (generally just two), usually with a curtain separating the beds.
Service Area: The area within which a private health plan or Medicare private drug planprovides medical services to its members. In many private health plans, the area where yournetwork of providers is located.
SHIP (State Health Insurance Assistance Program): A federally-funded program in each state that answers questions about Medicare, free of charge.
Skilled Care: Medically necessary care performed by a skilled nurse or therapist. If a home health aide (someone who provides help with activities of daily living) or other person can perform the service, it is not considered skilled care. Skilled nursing includes care from Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Skilled therapy includes care from licensed physical, occupational and speech therapists.
Skilled Nursing Facility (SNF): A Medicare-approved facility that provides short-term post-hospital extended care services, at a lower level of care than provided in a hospital.
Skilled Nursing Services: Services from a registered nurse, which include administration of medications; tube feedings; catheter changes; wound care; teaching and training activities; observation and assessment of a patient's condition; and management and evaluation of a patient's plan of care.
Skilled Therapy Services: Services from licensed physical, speech/language, and occupational therapists (if originally accompanied by physical therapy or speech/language pathology services). Physical therapy services which qualify people for home health careinclude: assessment; therapeutic exercises; gait training; range of motion tests; ultrasound, shortwave, and microwave diathermy treatments; teaching services; and development, implementation, management, and evaluation of a patient plan of care. Maintenance care is covered if a physical therapist's skills are necessary for the safe and effective provision of repetitive services which use complex, sophisticated procedures.
SLMB (Specified Low-Income Medicare Beneficiary Program): Federal program administered by each state's Medicaid program that pays the Part B premium for people with Medicare with low incomes.
SNP (Special Needs Plan): A Medicare private health plan (Part C) that exclusively or primarily serves members who have a particular special need. A SNP may serve people who have both Medicare and Medicaid (dual-eligibles); people who have a specific chronic illness, like diabetes; or people who are in long-term care facilities or require an institutional level of care. Some SNPs may serve more than one type of special need.
Social Security Administration (SSA): The United States government agency responsible for advancing the economic security of Americans through shaping and managing various programs, including Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) and Extra Help.
Special Election Period: A set period of time from October 1 through December 31 of every year when you can switch to another Medicare private health plan (Part C) if your plan is closing and another one is available in your area. During this time, Medicare private plans must enroll individuals who apply whose private plans are closing.
Special Enrollment Period (SEP): A period of time outside of the general enrollment periodor open enrollment period, triggered by specific circumstances, during which you can enroll inMedicare Part B, Part D, or a private health plan (Part C). SEPs may also allow you to switch or disenroll from Part D and private health plans. In Part B, an SEP absolves you from having to pay a premium penalty. Your Part B SEP begins the month after your or your spouse’s employment or group health plan coverage ends (whichever comes first). In Part D and private health plans, you are eligible for an SEP in many situations; for example, if you were to lose any type of drug coverage that was considered creditable coverage or you were to move out of your plan’s service area. Only two Part D SEPs absolve you from the premium penalty: getting Extra Help and receiving inadequate information about the creditability of your drug coverage.
Specialist: A doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems.
Speech/Language Pathology: Therapeutic treatment of speech impairments (such as lisping and stuttering) or speech difficulties that result from illness.
Speech Therapy: See Speech/Language Pathology.
SSDI (Social Security Disability Insurance): Monthly benefits provided through the United States Social Security Administration for people who lose their ability to work because of a severe medical impairment (disability). People who receive SSDI for 24 months are eligible for Medicare.
SSI (Supplementary Security Income): Monthly benefits for people with low incomes andassets who are 65 or older, blind, or have a disability.
State Pharmaceutical Assistance Program (SPAP): State-subsidized programs that provide assistance in paying for prescription drug costs. SPAPs vary by state.
Step Therapy: A coverage restriction placed on drug coverage by private health plans andMedicare private drug plans. Before your plan will cover some (generally more expensive) drugs, you must try other (generally less expensive) drugs that treat your condition to see if they will be effective for you.
Supplemental Insurance: Fills gaps in Original Medicare coverage by helping to pay for the portion of health care expenses that Original Medicare does not pay for, such as deductiblesand coinsurances. Supplemental insurance includes Medigap plans and retiree insurancefrom a former employer. Supplemental insurance may offer additional benefits that Medicare does not cover. See also, Secondary Insurance.
Supplier: A person or business from whom you can buy medical equipment, like a walker or wheelchair. See also Provider and Durable Medical Equipment (DME).
T
Take Assignment: A term used to describe an agreement by a doctor to accept Medicare'sapproved amount for a service or item as payment in full. See also, Participating Providerand Non-Participating Provider.
Temporary First Fill: See Transition Policy.
Terminal Illness: A disease or condition that cannot be cured or adequately treated, and is expected to result in eventual death.
Therapy Caps: Limits on the amount of physical therapy, occupational therapy andspeech/language pathology that Medicare will cover in a given year.
Tiers: See Cost Tiers.
Transition Policy: Also called a “temporary first-fill.” Allows new members of Medicare private drug plans (Part D) to get temporary coverage of drugs they were taking when they joined if those medications are not covered by their new plan.
TRICARE: The Department of Defense’s health insurance program for active duty and retired military personnel and their family members. TRICARE consists of several different programs, including TRICARE for Life (TFL), a retiree benefit that acts as supplemental insurance to Medicare. TRICARE also offers coverage to reserve force members who are on active duty for 30 days or more.
TRICARE for Life: The health insurance program for military retirees who have served honorably for at least 20 years. They must be enrolled in Part B to receive the benefits. It payssecondary to Medicare and covers out-of-pocket costs including deductibles andcoinsurance. People who qualify can receive free or low-cost medications from military treatment facilities, TRICARE network and out-of-network pharmacies, and the National Mail Order Pharmacy.
U
Unearned Income: Money you get from sources other than current employment. Includes Social Security benefits, Veterans benefits, pensions, annuities and other regular payments you receive, such as alimony and workers' compensation.
Urgent Care: Immediate medical attention for a sudden illness or injury that is not life threatening.
Unskilled Care: See Personal Care.
Utilization Management Tools: See Coverage Restrictions.
