I-SNP Medicare Advantage plans have a unique advantage over other types of Medicare Advantage plans: they offer tailored benefits for people who are living in a medical facility or institution. These tailored benefits ensure residents get the care they need in the manner they require it.
Not everyone is eligible to enroll in an I-SNP Medicare Advantage plan. Today, we’ll review the benefits of these plans, discuss who is eligible to enroll, and important enrollment deadlines.
What Is an Institutional Special Needs Plan?
An Institutional Special Needs Plan, or I-SNP, is one type of Medicare Advantage Special Needs Plan. It’s geared towards Medicare beneficiaries who reside in a health institution. Some facility types include:
- Long-term care nursing facility (NF)
- Long-term care skilled nursing facility (SNF)
- Inpatient psychiatric facility
- Intermediate care facility (ICF/DD) for those with intellectual disabilities
To be eligible for an I-SNP, a physician must declare that you will need to stay in the facility for at least 90 days. Or, a physician could also attest that you need an “institutional-equivalent” level of healthcare. In this second case, you need to meet two conditions.
- A determination that you need an institutional level of care (LOC) based on your state’s assessment tool. If the state does not have an assessment tool in place, the I-SNP will use the same determination methodology used in respective states.
- The I-SNP must arrange for the LOC assessment to be independently administered by a third party not owned by the I-SNP carrier.
So, what exactly does a Medicare Advantage I-SNP offer? I-SNPs offer benefits, services, and prescription drug formularies that are relevant to people who live in these medical institutions. In most cases, all your medical care will take place within the facility. This eliminates the need for travel and is convenient for the residents.
All Medicare Advantage plans must offer at least as many benefits as Original Medicare (Parts A and B). These standard services include preventive care, lab tests, inpatient care, prescriptions, emergency room visits, ambulance transportation, and durable medical equipment. I-SNPs also assign a care coordinator to each enrollee, who will help keep track of all your appointments and treatment.
I-SNPs must create a detailed Model of Care (MOC), which must be approved by the Centers for Medicare and Medicaid Services. A Model of Care outlines how beneficiaries will receive care, which ensures the plan gives a proactive and preventive approach to healthcare.
How to Enroll in a Medicare Advantage I-SNP
If you meet the eligibility criteria for an I-SNP, you can enroll as soon as you have completed your enrollment into Original Medicare. Most often, this is around the time of your 65th birthday. However, Medicare is also available to younger individuals who have long-term disabilities or certain medical conditions.
You may also switch to an I-SNP from another type of Medicare plan during Medicare’s Annual Election Period (AEP). If you require admission into an institution or are released from one, you’ll also be eligible for a Special Enrollment Period (SEP) that will allow you to switch plans at any time of the year.
Not all beneficiaries will have access to an I-SNP, even if they are eligible for one. You may only enroll in a Medicare Advantage plan that is available within your residential zip code.
To learn more about I-SNP Medicare Advantage plans, call the independent insurance agents at Carolina Senior Benefits. Our advisors will help you determine which plans you’re eligible for and guide you through the enrollment process. Call today to speak with a Medicare expert!
