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 disenroll you if you move out of the plan's service area.
|Skilled Nursing Facility||
A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.
|Specified Low - Income Medicare Beneficiary (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.
A number of stars will be given to each plan to indicate how well a plan performs on that particular category or measure. Star ratings range from 1 star to 5 stars, where a rating of 1 star means "poor" quality and 5 stars means "excellent" quality, for a category or measure.
In some cases, plans require you to first try one drug to treat your medical condition before they will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, a plan may require your doctor to prescribe Drug A first. If Drug A does not work for you, then the plan will cover Drug B.
*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.