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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
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 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 disenroll 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.
SIGNIFICANT BREAK IN COVERAGE	Generally, a significant break in coverage is a period of 63 consecutive days during which an individual has no creditable coverage. In some states, the period is longer if the individual’s coverage is provided through an insurance policy or HMO. Days in a waiting period during which you had no other health coverage cannot be counted toward determining a significant break in coverage.
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 includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
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.
SKILLED NURSING FACILITY CARE	This is a level of care that requires the daily involvement of skilled nursing or rehabilitation staff and that, as a practical matter, can’t be provided on an outpatient basis. Examples of skilled nursing facility care include intravenous injections and physical therapy. The need for custodial care (for example, assistance with activities of daily living, like bathing and dressing) cannot, in itself, qualify you for Medicare coverage in a skilled nursing facility. However, if you qualify for coverage based on your need for skilled nursing or rehabilitation, Medicare will cover all of your care needs in the facility, including assistance with activities of daily living.
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	A set time when you can sign up for Medicare Part B if you didn?t take Medicare Part B during the Initial Enrollment Period, because your or your spouse were working and had group health plan coverage through the employer or union. You can sign up at anytime you are covered under the group plan based on current employment status. The last eight months of the Special Enrollment Period starts the month after the employment ends or the group health coverage ends, whichever comes first.
SPECIAL NEEDS PLAN	A special type of plan that provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or who have certain chronic medical conditions.
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 DISEASE INSURANCE	This kind of insurance pays benefits for only a single disease, such as cancer, or for a group of diseases. Specified Disease Insurance doesn?t fill gaps in your Medicare coverage.
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.
SPEECH-LANGUAGE THERAPY	Treatment to regain and strengthen speech skills.
SPONSOR	An entity that sponsors a health plan. This can be an employer, a union, or some other entity.
STATE CHILDREN’S HEALTH INSURANCE PROGRAM	Free or low-cost health insurance is available now in your state for uninsured children under age 19. State Children?s Health Insurance Programs help reach uninsured children whose families earn too much to qualify for Medicaid, but not enough to get private coverage. Information on your state?s program is available through Insure Kids Now at 1-877-KIDS NOW (1-877-543-7669). You can also look at www.insurekidsnow.gov on the web for more information.
STATE HEALTH INSURANCE ASSISTANCE PROGRAM (SHIP)	A State program that gets money from the federal government to give free local health insurance counseling to people with Medicare.
STATE INSURANCE DEPARTMENT	A state agency that regulates insurance and can provide information about Medigap policies and other private insurance.
STATE MEDICAL ASSISTANCE OFFICE	A state agency that is in charge of the state’s Medicaid program and can give information about programs that help pay medical bills for people with low incomes.
STATE PHARMACY ASSISTANCE PROGRAM	A state program that provides people assistance in paying for drug coverage, based on financial need, age or medical condition and not based on current or former employment status. These programs are run and funded by the states.
STATE SURVEY AGENCY	Agency that inspects dialysis facilities and makes sure that Medicare standards are met.
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.
SUBSIDY	A monetary grant paid by the government to a private person or company to assist an enterprise deemed advantageous to the public
SUPPLIER	Generally, any company, person, or agency that gives you a medical item or service, like a wheelchair or walker.

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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