Nursing Homes
Alternatives to Nursing Home Care
Social Managed Care Plan
A Social Managed Care Plan is an organization that provides the full range of
Medicare benefits offered by standard Managed Care Plan's plus additional services
which include care coordination, prescription drug benefits, chronic
care benefits covering short term nursing home care, a full range of
home and community based services such as homemaker, personal
care services, adult day care, respite care, and medical
transportation. Other services that may be provided include
eyeglasses, hearing aids, and dental benefits. These plans offer the
full range of medical benefits that are offered by standard Managed Care Plan's
plus chronic care/ extended care services. Membership offers other
health benefits that are not provided through Medicare alone or
most other senior health plans.
Current Social Managed Care Plan Sites
There are currently four Social Managed Care Plan's participating in Medicare and each
Social Managed Care Plan has eligibility criteria. These Social Managed Care Plans are located in:
Portland, Oregon; Long Beach, California; Brooklyn, New York; and
Las Vegas, Nevada. Listed below are the four plans and the criteria
for joining each plan.
- Kaiser Permanente, Portland Oregon
The enrollee must be 65 years of age or older, must have
Medicare Part A and Part B, must continue to pay the Part B
premium and must live in Kaiser Permanente's Social Managed Care Plan service
area. The enrollee cannot have end-stage renal disease, or
reside in an institutional setting. In order to receive the
long-term care benefit, an expanded care resource coordinator
will visit you at home to determine if you qualify for nursing
home certification based on criteria established by the State of
Oregon Senior and Disabled Services. These criteria may
include needing daily ongoing assistance from another person
with one of the following activities of daily living: walking or
transferring indoors, eating, managing medications, controlling
difficult or dangerous behavior, controlling your bowels or
bladder, or the need for protection and supervision because of
confusion or frailty.
- SCAN, Long Beach California
The enrollee must be 65 years of age or older, must have
Medicare Part A and Part B, must continue to pay the Part B
premium and must live in SCAN's service area. The enrollee
cannot have end-stage renal disease. In addition, in order to
receive extended home care services, members must have a
Nursing Home Certificate which indicates that the members
informal support system , such as a family member or care
giver, is not sufficient to keep the member out of a nursing
home.
- Elderplan, Brooklyn, New York
The enrollee must be 65 years of age or older, must have
Medicare Part A and Part B, must continue to pay the Part B
premium and must live in Elderplan's service area. The enrollee
cannot have end-stage renal disease. In order to receive
chronic care benefits, the enrollee must meet state nursing
home certifiable criteria.
- Health Plan of Nevada, Las Vegas, Nevada
The enrollee must be at least 65 years of age, or may under 65
if they are disabled. The enrollee must have Medicare Part A
and Part B, must continue to pay the Part B premium and must
live in Health Plan of Nevada's service area. The enrollee
cannot have end-stage renal disease. For the long-term care
benefit, the beneficiary must meet certain criteria based on
established medical, psychological, functional, and social
criteria as well as needing to be medically necessary.
Your Cost
Each plan has different requirements for premiums. All plans have
co-payments for certain services. To obtain cost and benefit
information, please visit our
Medicare Options Compare tool for
specific details. Before making any health plan decisions, you
should contact the plan directly using the phone number listed in
the site.
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