Term Medicare Special Needs Plan Enrollment
Code NS-8000.5000-480.60
Definition Sponsors of Medicare Advantage health care plans approved by Medicare that accept applications for enrollment in specialized plans that limit membership to individuals with special needs, i.e., people who are living in an institution (such as a nursing home), require nursing care at home or who reside in the community but require an equivalent level of care as those residing in a long term care facility; people with both Medicare and Medicaid (dual eligibles); and/or people who have severe or disabling chronic conditions (e.g., cardiovascular disease, diabetes, congestive heart failure, mental disorders, end stage renal disease and HIV/AIDS). The plans tailor their benefits, provider choices and drug formularies (list of covered drugs) to best meet the needs of the groups they serve. The SNP offers all Medicare health care services and prescription drugs as well as more focused care that may be needed to manage a disease or condition. Participants generally must receive care from the physicians, hospitals and other providers in the SNP provider network.
Created 2/13/08
Changed 3/6/18
Use References Medicare SNP Enrollment
See Also References
External Classification Terms Health (CAN HC-300)
Health Care (USA HC-300)
Health Insurance (NPC Y02.03)
Health Insurance for the Aged and Disabled-Hospital-MEDICARE (UW
Health Insurance for the Aged and Disabled-Supp Ins-MEDICAR (UW
Insurance Providers (NTE Y20)
Related Concepts Disabilities
Financial Services/Benefits
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 Centers for Medicare & Medicaid Services (CMS) website, http://www.cms.hhs.gov

Privacy Policy. Terms of Use. Contact 211 LA County.