What are Institutional Special Needs Plans (I-SNPs)?
Some insurance providers offer Medicare Advantage plans that tailor their benefits to the healthcare needs of a specific group of people. These plans are called Special Needs Plans.
One type of Special Needs Plan is an Institutional Special Needs Plan (I-SNP), which caters to people who rely on care in a long-term setting. In this blog, we’ll go over who is eligible for this type of plan, what kind of coverage is included in I-SNPs, and how to enroll.
Key takeaways:
I-SNPs are specialized Medicare Advantage plans that tailor coverage to people who need the level of care provided by an institutional facility.
Common benefits I-SNPs include are care coordination, specialist visits, and long-term services like custodial care and respite care.
Out-of-pocket costs, benefits, and other plan details can vary between I-SNPs, insurance carriers, and location.
Finding and enrolling in the right I-SNP can be complicated—speak to a licensed Medicare Advisor to know your options and understand plans.
What is a Special Needs Plan?
6,782,273 Medicare beneficiaries are enrolled in a Medicare Advantage Special Needs Plan. These plans are specialized and tailor benefits to a certain group of people. There are three types of Special Needs Plans:
Chronic Conditions Special Needs Plans (C-SNPs): for people with certain chronic conditions
Dual-Eligible Special Needs Plans (D-SNPs): for people eligible for both Medicare and Medicaid
Institutional Special Needs Plans (I-SNPs): for people who need the level of care provided by institutional facilities
Like standard Medicare Advantage plans, I-SNPs are offered by private insurance carriers. Plan availability varies by location and may change yearly. It’s up to insurance companies to determine their coverage within Special Needs Plans, so make sure you understand plan details and read them carefully.
What are I-SNPs?
I-SNPs are Medicare Advantage plans designed to meet the needs of people who need the level of care at an institutional facility. This can include long-term care at facilities such as:
Skilled nursing facilities
Inpatient psychiatric facilities
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Community-based facilities
I-SNPs tailor their benefits, provider choices (including specialists), drug formularies, and services to best meet the needs of people who need long-term care. The specific facilities, benefits, and details covered in I-SNPs can vary by insurance provider, plan, and county. Check the coverage details of I-SNPs carefully before enrolling to ensure you have the coverage you need and can afford.
To clarify, I-SNPs don’t cover the actual stay in an institutional setting. Rather, these plans provide better healthcare coverage for people who already live in places like assisted living residences or long-term care facilities.
IE-SNP vs. I-SNP
IE-SNPs are a type of I-SNP called an Institutional-Equivalent Special Needs Plan. These plans are for people who need long-term care but can stay at home. In some cases, you can have an IE-SNP while residing in a nursing home setting or assisted living residence. IE-SNPs are best for people who prefer to age in place or want to remain in a familiar setting while receiving care.
What benefits does an I-SNP include?
Medicare beneficiaries who need I-SNPs require extra support. In addition to what's covered by Original Medicare and standard Medicare Advantage plans, I-SNPs often include the following benefits:
Specialist visits for specific chronic or disabling conditions
Comprehensive drug coverage and tailored formularies
Care coordination and personalized attention from healthcare providers, caregivers, and social workers
Speech-language pathology
Transportation services to doctor appointments and other places
Preventive services and health education
Vision, hearing, and dental care
Long-term services like custodial care and respite care
Mental health services
Wellness programs
I-SNPs and other Medicare Advantage plans must cover all services that Original Medicare does. Not all of the benefits above are included in every Institutional Special Needs Plan and some plans may include coverage for other services. Some I-SNPs may also include coverage for specific institutional care.
Out-of-pocket costs for I-SNPs
Out-of-pocket costs for an I-SNP vary between plans. In general, Medicare Advantage premiums, copays and coinsurance, out-of-pocket maximums, and deductibles depend on the individual policy.
Does Original Medicare cover long-term care?
Original Medicare, Medicare Supplement plans, and standard Medicare Advantage plans don’t cover long-term care. Medicare does cover short-term stays at a skilled nursing facility, short-term home health care, and 90 days of care at a long-term acute care hospital.
For people on Medicare who have chronic conditions, but don’t need the level of care from an institutional facility, chronic care management may be a good alternative.
Enroll in a Special Needs Plan
Between their relatively limited availability and varying details, Institutional Special Needs Plans are difficult to find and understand. Get in touch with a Chapter Medicare Advisor at 855-900-2427 or schedule a time to chat to get help comparing plans and finding the right coverage for your needs.