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Get to Know Medicare’s Institutional Special Needs Plans (I-SNP)

What Is an I-SNP, or Medicare Institutional Special Needs Plan?

An Institutional Special Needs Plan, also known as an I-SNP, is a type of Medicare Advantage plan tailored for beneficiaries who require an institutional level of care. They are specifically designed for those living in long-term care settings such as a nursing home, skilled nursing facility, intermediate care facility, or inpatient psychiatric facility.

I-SNPs provide a comprehensive health care package, offering a combination of medical, preventive, and supportive services. I-SNP plans are required to provide, at a minimum, the same coverage as Original Medicare (Medicare Parts A and B) but may also have additional benefits, such as prescription drug coverage explicitly designed for individuals receiving long-term care.

What Are Medicare Special Needs Plans?

Medicare Special Needs Plans (SNPs) are a subset of Medicare Advantage plans specifically designed to cater to beneficiaries with distinct and unique requirements. This may include individuals with particular chronic conditions, those eligible for both Medicare and Medicaid, or those requiring an institutional level of care.

Unlike standard Medicare Advantage plans, SNPs are created to provide benefits, services, and, sometimes, drug formularies best suited to their targeted group. For example, an SNP that covers individuals with severe conditions may cover extra inpatient hospital days. SNPs typically also offer care coordination services designed to help streamline healthcare for covered individuals.

Typically, an individual must continue to meet the plan’s eligibility criteria to remain enrolled in an SNP. For example, if you were no longer in a long-term care facility, you may find that you’re no longer eligible for an I-SNP plan.

How Does an I-SNP Work?

Several primary characteristics define I-SNP plans and set them apart from other types of plans. First, an I-SNP is intended to provide covered individuals with the medical and supportive services they need at a single location, streamlining their healthcare needs. These plans eliminate the need to travel for essential preventive care like vaccinations and reduce the need for emergency room visits and prolonged hospital stays.

Some of the services covered by an institutional special needs plan include:

To ensure proactive and personalized healthcare, the Centers for Medicare and Medicaid Services (CMS) also requires each I-SNP to have a Model of Care (MOC). An MOC is a comprehensive document that explains each individual’s specific healthcare needs and how the facility meets them. It’s designed, in part, to reduce or even stop declines in a patient’s health and/or mental well-being.  

The rising popularity of both Medicare Advantage Plans and I-SNPs has underscored the preference for comprehensive care. In 2023, more than 5.7 million Medicare recipients chose to enroll in a Special Needs Plan, a number that is double the SNP enrollment in 2018. Enrollment in SNPs increased by 24% between 2022 and 2023, while enrollment in I-SNPs increased by 10% over the same time period. 

Eligibility Criteria

To be eligible for an I-SNP, you must be enrolled in Original Medicare and reside in the plan’s service area. In addition, you must need or be expected to need long-term care in an institutional setting for a minimum of 90 days. This must be documented via a needs assessment tool, typically provided by the state and completed by a qualified impartial party.

What Is an IE-SNP?

An IE-SNP, or Institutional-Equivalent Special Needs Plan, is generally the same as an SNP but caters to those who may not live within institutional settings but still require an institutional level of care (LOC). Individuals who choose to stay in their homes may be eligible for an IE-SEP by completing a needs assessment that documents their need for institutional-level care, similar to the assessment required for an I-SNP.

Once an individual is deemed eligible and enrolled in the plan, the IE-SNP typically covers many of the services covered under an I-SNP. Like an I-SNP, an IE-SNP focuses on preventative care and reducing the need for emergency or inpatient hospital care.

Why Enroll in an I-SNP?

For individuals needing institutional-level care, several potential benefits may come from choosing an I-SNP over a regular Medicare Advantage plan or Original Medicare. This includes:

  • Integrated Care: Medical, preventative, and support services are typically provided in one location, reducing the hassle of juggling multiple healthcare providers and the need to travel to various locations.
  • Specialized Focus: Since I-SNPs cater to individuals with specific care needs, they help ensure that covered individuals can access facilities and healthcare professionals that meet their requirements. This may help ensure optimized care.
  • Comprehensive Coverage: I-SNPs typically provide additional benefits beyond what is offered by Original Medicare, helping to avoid potential gaps in coverage.
  • Reduced Out-of-Pocket Costs: Due to the specialized nature of care and preventive focus, enrollees typically find that they’re faced with fewer unexpected medical expenses.
  • Model of Care (MOC) Mandate: The mandated MOC ensures proactive and personalized healthcare, prioritizing a patient’s health and well-being.

How to Enroll in an I-SNP

Enrolling in an I-SNP is fairly straightforward and can be done by following these steps:

  • Check Your Eligibility: Begin by ensuring you have Medicare Part A and Part B and that you either reside in an institution or require consistent nursing care at home.
  • Research Plans: Explore the I-SNPs available in your area. The Medicare Plan Finder on the official Medicare website can be a useful tool. 
  • Consult with a Professional: Although this step is optional, consulting with Medicare professionals or trusted advisors may help you understand the specifics of each plan and how it aligns with your needs.
  • Choose a Plan and Contact the Provider: Reach out to the specific I-SNP provider for enrollment details and guidance.
  • Complete Enrollment: Follow the provided instructions to finalize your enrollment. This typically involves completing specific forms and potentially undergoing an assessment.
  • Review Your Plan Annually: Medicare Advantage plans, including I-SNPs, have annual enrollment periods. Be sure to review and reassess your choice each year to ensure your selection aligns with your evolving needs.

Putting It All Together

I-SNPs provide specialized care coverage for individuals who need long-term care in an institutional setting or institutional-level long-term care at home. The comprehensive and specialized care approach offered by I-SNP plans may create some significant advantages for eligible individuals, reducing the need to seek care in multiple locations. Using the MOC mandate also helps to ensure each patient receives personalized and proactive healthcare.

Once you’re confirmed that you’re eligible for an I-SNP, you can enroll by contacting the provider and following the enrollment instructions. Since Medicare Advantage Plans, including I-SNPs, change annually, it’s important to re-evaluate your plan selection each year to ensure it still meets your needs.

Frequently Asked Questions

You may be disenrolled from the plan if you no longer meet the eligibility criteria for an I-SNP. When this happens, you revert to Original Medicare or have the option to select a different Medicare Advantage Plan.

While I-SNPs are designed primarily for institutional beneficiaries or those needing consistent nursing at home, they do not directly cover the cost of residing in long-term care facilities like nursing homes. However, they do facilitate the comprehensive coordination of medical services beneficiaries receive within these settings, including routine check-ups, specialized treatments, and other medical services.

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