Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage plan you can subscribe to if you meet certain criteria.
To be eligible for an I-SNP, you must need the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home but require an equivalent level of care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
The costs associated with I-SNPs vary. You may still be required to pay your Medicare Part B premium, plus other costs such as copays, deductibles, and coinsurance.
- long-term care nursing facility
- long term care skilled nursing facility
- inpatient psychiatric facility
- intermediate care facility for individuals with developmental delays
To be eligible for an Institutional Special Needs Plan, you must be enrolled in Original Medicare (Part A and Part B). You must need or will need the level of services provided in an institutionalized setting for 90 days or more. You must also live in the county or local community where the institution you choose is licensed to operate.
If you have an I-SNP, you will get all or most of the medical and support services you require in one place. This eliminates the need to travel for preventive care, such as vaccinations and mammograms. It also reduces the need for stressful and disruptive emergency room visits and hospital stays.
Like all Medicare Advantage plans, an I-SNP must cover at least everything Original Medicare does. I-SNPs cover inpatient and outpatient services, including medically necessary treatments and preventive services. You will get medical tests and treatments done on a timely basis, without the stress of keeping track of your care requirements.
Some of the medical treatments and services covered by an I-SNP plan include:
- Vaccines, including flu shots and the shingles vaccine
- Durable medical equipment, including items such as walkers and oxygen monitors
- Prescription medications
- Laboratory tests
- In-patient hospital care
- Emergency room visits
- Clinical research
- Ambulance services
- Mental health services
The Centers for Medicare and Medicaid Services (CMS) requires I-SNPs to produce a detailed Model of Care (MOC). The Model of Care outlines how the facility will meet your medical needs. This ensures you will receive proactive, personalized care that can reduce or halt declines in your health and mental well-being.
To find out if there is an I-SNP near you or to enroll, you can contact a licensed GoHealth insurance agent. You can also contact Medicare, your State Health Insurance Assistance Program (SHIP), or call the plan directly.
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The costs for an I-SNP vary from plan to plan, just like they do for any Medicare Advantage plan. Some plans charge a monthly premium in addition to the Medicare Part B premium you are responsible for. Others may pay a portion of the Part B premium. Your plan may also have an annual deductible you must meet before your costs are covered. Other out-of-pocket costs may include coinsurance and copayments for medical services and treatments, medications, and durable medical equipment.
An Institutional-Equivalent Special Needs Plan (IE-SNP) is a type of I-SNP. It is for people who need the level of care given in a long-term care facility who can remain at home. Some people eligible for IE-SNPs live in group home settings or assisted living residences.
To be eligible for an IE-SNP, you must have Original Medicare. Other requirements typically include certification from your state of residence that you need this type of care.
Like an I-SNP, an IE-SNP will cover the same Part A and Part B services as Original Medicare.
The goal of an IE-SNP is to provide proactive, face-to-face care that reduces or eliminates the need for emergency room visits and hospitalizations. With this type of plan, you can remain in a comfortable, familiar setting while getting your medical needs met.
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Special needs plans are designed to meet the medical needs of a specific group of people who have a characteristic or condition in common. This allows the plan to provide the benefits, services, and drug formularies that are most relevant and necessary for this population.
I-SNPs are specifically designed to meet the needs of people who live or will live in an institutionalized setting for at least 90 days.
Other types of special needs plans center upon medical conditions, such as cancer or HIV/AIDS. Some focus on financial need. [i]
In addition to I-SNPs, special needs plans include:
- Chronic Conditions Special Needs Plans (C-SNPs) – for people with severe or disabling chronic medical conditions
- Dual Eligible Special Needs Plans (D-SNP) – for people who are eligible for Medicare and Medicaid
You may be eligible for more than one type of plan at any given time. You and your provider can determine which plan will be most effective for meeting your medical needs and keeping you healthy long-term.
I-SNPs rely heavily on the expertise of nurse practitioners. Based upon your medical needs, you will probably meet at least weekly with a nurse practitioner who is familiar with your chart and can make recommendations for your ongoing support. You may also see doctors and therapists, such as mental health professionals and physical therapists.
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