Portion of the SMI costs paid by the beneficiary after meeting the annual deductible. A measure of the average change in prices over time in a fixed group of goods and services. Funds included in the trust fund to serve as a cushion in case actual expenditures are higher than those projected at the time financing was established. Since the financing is set prospectively, actual experience may be different from the estimates used in setting the financing. An amount included in the actuarial rates to provide for changes in the contingency level in the trust fund.
Positive margins increase the contingency level, and negative margins decrease it.
Services for which SMI pays, as defined and limited by statute. Covered services include most physician services, care in outpatient departments of hospitals, diagnostic tests, DME, ambulance services, and other health services that are not covered by the HI program. The annual amount payable by the beneficiary for covered services before Medicare makes reimbursement. For Social Security purposes, the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or to last for a continuous period of not less than 12 months. Special rules apply for workers aged 55 or older whose disability is based on blindness.