Term Medicare HMO Plan Enrollment
Code NS-8000.5000-480.45
Definition Sponsors of Medicare Advantage (MA) health care plans approved by Medicare that accept applications for enrollment in a type of managed care organization that generally provides health care coverage through hospitals, physicians and other providers with which the HMO has a contract. Most HMOs require members to select a primary care physician to manage the individual's health care; a referral from a primary care physician to see specialists is generally required.
Created 2/13/08
Changed 3/6/18
Use References Medicare Health Maintenance Organization Plan Enrollment
See Also References
External Classification Terms Health (CAN HC-300)
Health Care (AIRS HC-300)
Health Insurance (NPC Y02.03)
Health Insurance for the Aged and Disabled-Hospital-MEDICARE (UW 2.4.14.01)
Health Insurance for the Aged and Disabled-Supp Ins-MEDICAR (UW 2.4.14.02)
Insurance Providers (NTE Y20)
Related Concepts Disabilities
Financial Services/Benefits
Insurance
Long Term Care
Named Programs
Older Adults
U.S. Services/Targets
Facet Service
Comments NOTE: A lot of different types of programs help people complete and file application/enrollment forms for various types of benefits and/or are authorized, usually by contract, to do eligibility determinations for a specific program. Note that for some programs, eligibility determinations can only be handled by a government agency. With so many different types of players, it is sometimes difficult to decide which Taxonomy term to select. Here are some guidelines: Use the Benefits Assistance terms in the FT-1000 section for application assistance provided by programs devoted primarily to advocacy for people to ensure that they understand and receive the benefits for which they are eligible. Use Benefits Screening (PH-0700) for programs that provide application assistance in the context of a general assessment of an individual's eligibility for a wide variety of benefits. Use the application/enrollment terms in the NL and NS sections of the Taxonomy for both federal, state, provincial or county offices tasked with benefits application/enrollment processing and eligibility determinations. Use Certificates/Forms Assistance (FT-1020) for assistance with any of the wide variety of forms, certificates and other official documents that people need to read and understand or complete and file that do not have a high enough profile to be covered by a dedicated Taxonomy term. Specific to Health Insurance, use Medicaid Information/Counseling (LH-3500.4900) and Medicare Information/Counseling (LH-3500.5000) for programs that offer information and guidance for people who may qualify for these benefits with the objective of empowering them to make informed choices. Help may include information about the programs themselves (eligibility requirements, specific benefits covered, rights of beneficiaries, coverage denials and appeals) as well as help with enrollment and assistance in completing related forms.
Bibliographic References

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