We use cookies to improve security, personalize the user experience,
enhance our marketing activities (including cooperating with our marketing partners) and for other
business use.
Click "here" to read our Cookie Policy.
By clicking "Accept" you agree to the use of cookies. Read less
Understanding the Social Health Maintenance Organization (SHMO) and Its Benefits
Definition & Meaning
A social health maintenance organization (SHMO) is a type of healthcare organization that provides a comprehensive range of Medicare benefits similar to those offered by standard health maintenance organizations (HMOs). In addition to basic Medicare services, SHMOs offer extra services, including:
Prescription drug benefits
Care coordination
Chronic care benefits, including short-term nursing home care
Home and community-based services, such as homemaker services, personal care, adult day care, respite care, and medical transportation
Vision, hearing, and dental benefits
SHMOs serve both disabled and able-bodied elders, taking on the financial responsibility for the services they provide. They operate on a prepaid capitation basis, meaning they receive a fixed amount per member for providing care.
Table of content
Legal Use & context
SHMOs are primarily relevant in the context of healthcare law and Medicare regulations. They are involved in legal practices related to:
Healthcare access and benefits
Insurance regulations
Medicare compliance
Users may find it beneficial to utilize legal templates from US Legal Forms to navigate eligibility requirements, service agreements, or appeals related to SHMO services.
Key legal elements
Real-world examples
Here are a couple of examples of abatement:
Example 1: An elderly person living in Portland, Oregon, enrolls in a local SHMO and receives assistance with home care services and prescription medications, which are covered under their plan.
Example 2: A disabled elder in Brooklyn, New York, utilizes adult day care services and medical transportation provided by their SHMO, ensuring they receive necessary care while maintaining independence.
State-by-state differences
State
SHMO Availability
Eligibility Criteria
Oregon
Yes
Varies by plan
California
Yes
Varies by plan
New York
Yes
Varies by plan
Nevada
Yes
Varies by plan
This is not a complete list. State laws vary, and users should consult local rules for specific guidance.
Comparison with related terms
Term
Description
Key Differences
Health Maintenance Organization (HMO)
A type of health insurance plan that provides a range of healthcare services through a network of providers.
SHMOs include additional services for seniors and disabled individuals.
Preferred Provider Organization (PPO)
A managed care organization that offers more flexibility in choosing healthcare providers.
SHMOs focus on comprehensive care for specific populations, while PPOs offer broader provider access.
Common misunderstandings
What to do if this term applies to you
If you are considering enrolling in a SHMO or need assistance with services, follow these steps:
Research the SHMO options available in your area.
Review the eligibility requirements and benefits of each plan.
Consider using US Legal Forms to access templates for applications or service agreements.
If you have complex needs or encounter issues, consult a legal professional for personalized guidance.
Find the legal form that fits your case
Browse our library of 85,000+ state-specific legal templates.