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.
Stars for each plan show how well the plan performs in that particular category. Star ratings range from 1 star to 5 stars, where a rating of 1 star means "poor" quality and 5 stars means "excellent" quality.
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. If a drug has step therapy restrictions, you will need to work with the plan and your doctor to obtain an exception.
|Subsidy Status Unknown||
Medicare doesn't have any information about your extra help status.
|Summary Rating of Health Plan Quality||
This summary rating gives an overall score on the health plan's quality and performance on 33 different topics in 5 categories:
The information described above is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare's regular monitoring activities.
|Summary Rating of Prescription Drug Plan Quality||
This summary rating gives an overall score on the drug plan's quality and performance on 19 different topics in 4 categories:
This information is gathered from several different sources, including results from Medicare's regular monitoring activities, reviews of billing and other information that plans submit to Medicare, and Medicare's member surveys.
*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.