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What Are Institutional Special Needs Plans?

What Are Institutional Special Needs Plans?

Did you know that Medicare has Institutional Special Needs Plans that can help cover institutional care? Call our licensed agents at (800) 950-0608 to learn more about these special plans today.

Just the Essentials:

  • Institutional Special Needs Plans (I-SNP) are designed to help cover institutional care.

  • To qualify for an I-SNP, you must meet specific criteria.

  • If you live at home, but require a similar level of care, you may be eligible for a different type of Medicare special needs plan.

  • Depending on your SNP type, costs will vary.

Medicare Special Needs Plans Can Help Cover Institutional Care

Last month, we discussed Medicare Special Needs Plans and how they can help cover an array of treatments and services not covered by Original Medicare, or even some Medicare Advantage plans. These special Medicare Advantage plans can help you cover anything from chronic health conditions to institutional care.

Wait a second, did we say “institutional care”? Not even Medicare Part A, the hospital insurance arm of Original Medicare, covers that! Well, not completely, anyway.

That’s right, one of the Special Needs Plan types offered is an institutional care plan. If you know that you’ll need long-term institutional services for a loved one, knowing about Institutional Special Needs Plans is a must for Medicare planning. Let’s take a look at how Institutional Special Needs Plans can work for you or a loved one.

How Do Institutional Special Needs Plans Work?

If you’re familiar with Medicare Part A, you know that it covers hospital stays deemed to be medically necessary. This only covers hospitalization for around 150 days or so, not long-term institutionalization. If you know that a loved one is going to need institutional care, it’s important to include special need types in your Medicare planning when considering coverage.

An Institutional Special Needs Plan, or I-SNP, is a type of special needs plan available to individuals who are eligible for Medicare Advantage insurance. An I-SNP is designed to help cover care for individuals who are currently receiving, or are expected to receive medical and healthcare services from a specialized institution for 90 days or more

The types of long-term care facilities in which Institutional Special Needs Plans cover care and services include:

  • Long-term care skilled nursing facilities.
  • Long-term care nursing facilities.
  • Intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDD).
  • Inpatient psychiatric facilities. 

Like any Medicare Advantage plan, an Institutional Special Needs Plan must offer the same coverage as Original Medicare. This means that they must offer the same medical treatments and preventive services that are covered by Medicare Part A and Medicare Part B. Institutional Special Needs Plans also offer coverage for the following treatments and services below, plus more:

  • Vaccines
  • Prescription medications
  • Lab tests
  • Emergency room visits
  • Ambulance services
  • Mental health services

Under CMS guidelines, I-SNPs must include a detailed Model of Care (MOC). The Model of Care ensures that you will receive care that meets your own individual needs. This allows for personalized care that can help you combat declines in your physical and mental health.

Image of friendly young nurse with happy senior patient

How Do I Know if I’m Eligible For An I-SNP?

Like any Medicare plan, you must meet certain eligibility requirements in order to enroll in any type of Medicare Special Needs Plan. The primary requirement for eligibility is the same as any other type of Medicare plan: you must be eligible to enroll in Medicare. 

As obvious as that may sound, such a disclaimer is still very important. If considered individually without the “Medicare” tag, someone may believe that these plans are special types that anyone may enroll in despite their age and medical standing. These are indeed special Medicare Advantage plan types, and as such, Medicare eligibility is required for enrollment. 

The other eligibility requirements that you must meet before you can enroll in an I-SNP include:

  • You must be enrolled in Original Medicare
  • You must need the level of services provided in an institutional setting for 90 days or more
  • You must live in the county or community where the institution that you choose is licensed to operate

Even if you meet requirements, one of these special plans may not be available to you. During your Medicare planning, make sure your research includes seeking the availability of I-SNPs in your area. If Institutional Special Needs Plans are not available in your area, you or your loved one may want to find adjacent areas nearby in which an I-SNP is available.

Institutional Special Needs Plans Can Help Greatly With Coverage of Institutional Care

If you or a loved one is eligible for enrollment in a Special Needs Plan, such as an Institutional Special Needs Plan, the benefits are numerous. With SNPs or I-SNPs, you may have access to coverage that you may have never imagined with Original Medicare or general Medicare Advantage plans.

When you’re looking to enroll in an I-SNP near you, our licensed agents are available to help you find one that’s right for you. If you have questions about Institutional Special Needs Plans, please feel free to give us a call today at (800) 950-0608. If you’re ready to begin researching and comparing plans, our free plan finder is available below! Just enter your zip code to begin comparing plans today.

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