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Part 5 Key Terms
Part 5 Key Terms - Working with Older Adults
| Term | Definition |
|---|---|
| 1115A demonstration program | Medicaid rule that offers flexibility to states in delivering Medicaid long-term care services. |
| Activities of daily living (ADLs) | Functions that are part of daily living that a person without disability can perform without assistance: eating, bathing, toileting, dressing, mobility (e.g., getting in or out of a bed or chair, walking), and continence. |
| Adjusted net countable income | The income a veteran (or surviving spouse) has after deducting unreimbursed medical expenses and a 5 percent deductible from his or her gross income. |
| Aid and attendance | The highest level of income-tax-free VA pension benefit that a veteran or surviving spouse may receive. In addition to meeting the basic pension requirements, the veteran or surviving spouse must also be dependent on others for care and survival. |
| Average indexed monthly earnings (AIME) | The result of averaging up to 35 years of a worker’s highest indexed earnings and rounding down to the next lower dollar amount. The AIME is used to calculate the worker’s primary insurance amount. |
| Balance billing | The prohibited practice of charging patients for the balance of any amounts not covered by Medicaid. |
| Basic pension (improved pension) | The income-tax-free benefit paid to veterans or their surviving spouses. |
| Benefit period | In the Medicare hospital and skilled nursing facility context, a benefit period starts on the day a beneficiary is admitted to a hospital as an inpatient and ends when they haven't received inpatient hospital or SNF care for at least 60 days in a row. |
| Categorically needy | Groups of individuals such as the aged, blind, or disabled who are, by definition, eligible for a needs-based program such as Medicaid when their assets and income fall below established thresholds. |
| Community spouse | A spouse who continues to live at home in the community while his or her spouse lives in a nursing home. |
| Community spouse resource allowance | Amount of assets that Medicaid regulations permit a community spouse to retain. |
| Consumer Price Index | An index measuring the change in the cost of typical wage earner purchases of goods and services, expressed as a percentage of the cost of these same goods and services in some base period. |
| Cost-of-living adjustment (COLA) | Adjustment of wages or salaries in proportion to changes in the cost of living. |
| Countable income | In eligibility determinations for needs-based programs such as Medicaid and SSI, countable income includes wages, Social Security payments, pension payments, and other income sources that are not exempt from consideration. |
| Countable resources | In eligibility determinations for needs-based programs such as Medicaid and SSI, countable resources include assets such as bank accounts, certificates of deposit, stocks, bonds, and other assets that are not exempt from consideration. |
| Delayed retirement credits | Social Security benefits are increased (by a certain percentage depending on a person’s date of birth) if retirement is delayed beyond full retirement age. |
| Dependency and indemnity compensation | An income-tax-free benefit paid to a veteran’s surviving spouse or other dependents if the veteran dies as a result of a service-connected disability or disease or dies for any reason while having received a 100 percent. |
| Disability rating | A numerical percentage in increments of 10 that corresponds to the degree of severity of a veteran’s disability or disease. This value is used to determine the veteran’s compensation amount. |
| Dual eligibles | Individuals who receive both OASDI and SSI benefits and therefore are eligible for Medicare and Medicaid. |
| Duration of work test | One of two tests a worker must pass to be eligible for Social Security disability benefits. To be fully insured, a worker must have worked a certain number of years prior to the disability. |
| Early retirement | The minimum age at which beneficiaries can begin collecting Social Security retirement benefits (age 62). Benefits are permanently reduced a fraction of a percent for each month before the beneficiary’s full retirement age. |
| Estate recovery | A process by which states recoup money they’ve spent on long-term care services from the estates of Medicaid recipients who have died. |
| Excluded income | Ineligibility determinations for needs-based programs such as Medicaid and SSI. |
| Exempt resource | For needs-based programs such as Medicaid and SSI, exempt resources are those that are not counted when determining a person’s eligibility for benefits. |
| Full retirement age | The age at which beneficiaries receive their full amount of Social Security benefits based on the year of birth. |
| Medicare Advantage plans/Medicare Part C | Alternatives to Original Medicare (Parts A and B). Medicare Advantage plans are the fee-for-service program that CMS administers. MA plans are Medicare for the beneficiaries who enroll in them.MA plan members are still enrolled in Medicare. |
| Medicare medical savings account (MSA) | A Medicare health plan option made up of two parts. One part is a Medicare MSA health policy with a high deductible. The other part is a special savings account, called a Medicare MSA. |
| Medicare Part D | A voluntary program in which private insurance companies, contracting with Medicare as stand-alone prescription drug plans (PDPs) or as Medicare Advantage plans, deliver the prescription drug benefit. Medicare savings programs. |
| Medicare summary notice (MSN) | A quarterly notice sent to beneficiaries that identifies the services or items a beneficiary received, the service providers and dates of service, the amounts Medicare approved for payment, the maximum amount the beneficiary owes out of pocket. |
| Medigap/Medicare supplement insurance | Insurance sold by private companies to beneficiaries with Original Medicare (Parts A and B) that supplements Medicare coverage by covering gaps in cost-sharing and benefits. Federal and state laws regulate Medigap plans. |
| Miller trust | An instrument to help people with too much income qualify for Medicaid. All the applicant’s income goes into the trust and is used to pay costs related to nursing home care beyond those covered by Medicaid. |
| Monthly maintenance needs allowance (MMNA) | A portion of the institutionalized spouse’s income that may be kept by the community spouse if he or she qualifies based on income. The MMNA is in addition to the Community Spouse Resource Allowance. |
| Needs-based program | Refers to public benefit programs such as SSI and Medicaid for which eligibility is based on financial need. The income and asset levels used to determine financial need vary among the programs. |
| Net worth | The amount of assets a veteran (or surviving spouse) is allowed to own in order to be eligible for VA pension benefits. There is no set formula for calculating allowable net worth for pension benefit purposes. |
| Noncountable (exempt) assets | Assets owned by the veteran or surviving spouse that the VA does not consider when determining allowable net worth. |
| Old Age and Survivors Insurance (OASI) | A trust funded by worker taxes under the Federal Insurance Contributions Act (FICA) and the Self-Employment Contributions Act (SECA) that is used to pay Social Security retirement and survivor benefits. |
| Old-Age, Survivors, and Disability Insurance (OASDI) | Social Security retirement and disability benefits. Beneficiaries are eligible for Medicare. |
| Original Medicare | Parts A and B of Medicare Insurance. |
| Pickle amendment | Medicaid eligibility screening tool that may allow certain beneficiaries who were eligible for SSI and Social Security in the same month to receive Medicaid benefits if their income increases to above the SSI threshold. |
| Presumptive condition | A veteran’s disease that the VA has determined was presumptively caused as a result of his or her military service. |
| Primary insurance amount (PIA) | The amount of monthly Social Security benefits the worker will receive at his or her full retirement age. The monthly benefit amount may be higher or lower than the PIA if the worker retires before or after full retirement age. |
| Qualifying service record | For VA compensation benefits, the veteran is not required to meet minimum length-of-service requirements; he or she must only have been discharged from service for reasons other than dishonorable. |
| Recent work test | One of two tests a worker must pass to be eligible for Social Security disability benefits. |
| Representative payee | An individual or organization that receives Social Security or SSI payments on behalf of an individual who cannot manage or direct someone else to manage his or her benefits money. |
| Service-connected disability compensation | An income-tax-free benefit paid to veterans who have sustained or aggravated a disability or disease as a result of their military service. The amount of compensation depends on the veteran’s disability rating. |
| Spending down | Refers to the process of depleting assets, or spending income on medical care or other eligible expenses, to qualify for Medicaid. |
| State Health Insurance Assistance Program (SHIP) | A federally funded program that offers free, one-on-one counseling and assistance to people with Medicare and their families via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities. |
| State Medicaid agency | Agency in each state responsible for administering the Medicaid program and developing a state Medicaid plan that CMS approves in light of federal regulations. |
| Supplemental Security Income (SSI) | A federal program administered by the Social Security Administration and funded by general tax revenues that provides income support payments to the aged, blind, or disabled. |
| TRICARE For Life | Lifetime health care benefits provided by the military to retirees; similar to secondary insurance plans that supplement Medicare. |
| Unreimbursed medical expenses | Certain expenditures that can be deducted from gross income in order to meet the adjusted net countable income test for purposes of determining VA pension eligibility and the benefit rate. |
| Veterans benefits | A variety of benefits and services offered by the US Department of Veterans Affairs for eligible veterans, including pensions and health, long-term care, and burial and memorial benefits. |
| General enrollment period | A period that starts on January 1 and ends on March 31 every year during which individuals can enroll in Medicare. |
| Home and community-based services | Services that allow people of all ages who have physical limitations to remain independent in the least restrictive setting possible and to be connected with their community. |
| Home and community-based services waiver | Also called 1915 waivers, these give states the authority and federal funding to develop and implement creative alternatives to institutionalization. |
| Housebound | Income-tax-free, midlevel VA pension benefit rate. Veteran or living spouse may receive this benefit if they meet basic pension requirements & substantially confined to the living space because of permanent & total disability rated 100 percent disabling. |
| Initial enrollment period | A seven-month window around a person’s 65th birthday in which he or she can sign up for Medicare Parts A and B. The seven months include the month of the individual’s birthday and the three months immediately before and after the birthday month. |
| Institutionalized spouse | Spouse who lives in a nursing home while the partner continues to live at home. |
| Look-back period | In eligibility determinations for Medicaid’s nursing home coverage, a 60-month time span before the application date during which an impermissible transfer of assets may result in a penalty period that delays Medicaid eligibility. |
| Maximum family benefit | The combined total amount of Social Security retirement benefits that a beneficiary and his or her eligible family members (auxiliary beneficiaries) can receive, generally between 150 and 180 percent of the primary beneficiary’s full retirement benefit. |
| Medically needy program | An optional program by which states can extend Medicaid eligibility to individuals with high medical expenses whose income exceeds an established limit but who'd otherwise be eligible for Medicaid by virtue. |
| Medicare | A federal health care program that provides hospital and medical insurance to people age 65 or older and to certain ill or disabled persons. Medicare does not cover custodial (long-term) care. |
| Medicare savings programs | Programs administered by Medicaid that pay Medicare premiums and Medicare deductibles, coinsurance charges, and copayments for beneficiaries who qualify. Income and asset thresholds are higher for these programs than those for full Medicaid benefits. |
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