What Is a Medicare Advantage I-SNP?

Medicare Advantage plans are one of the more difficult things to understand within the Medicare program. Every plan is different, and insurance carriers often offer more than one or two plans. One subset of Medicare Advantage (Part C) plans is called Special Needs Plans or SNPs. And within this subset is yet another: C-SNP, D-SNP, and I-SNP.  

What Is a Medicare Advantage I-SNP?

All Special Needs Plans are tailored to the group of individuals they serve. All SNP plans include prescription drug coverage. I-SNP stands for Institutional Special Needs Plan. You probably guessed by the name, but these plans are for Medicare beneficiaries who live in institutions like nursing homes. Other institutions that qualify include:

• Long-term care skilled nursing facility (SNF)
• Long-term care nursing facility (NF)
• SNF/NF
• Intermediate care facility (ICF/DD) for those with intellectual disabilities
• Inpatient psychiatric facility

You must have had (or expect to need) a stay of at least 90 days or more in one of the above facilities to enroll in an I-SNP. In addition, you could also qualify if you need an “institutional-equivalent” level of care. In this case, you’ll need to meet two conditions.

1. 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.
2. 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 does an I-SNP offer that makes it different than other kinds of Medicare Advantage plans? I-SNPs provide services, benefits, and prescription formularies that are relevant and necessary for people who live in health institutions. If you are enrolled in an I-SNP, most (if not all) of your medical services will occur in one place. This is helpful because it eliminates the need for travel to get access to preventive care like vaccines. It also reduces the likelihood of needing emergency room visits and hospital stays.

As with all Medicare Advantage plans, I-SNPs must offer at least as much coverage as is found in Original Medicare (Parts A and B). They include inpatient and outpatient benefits, plus the help of a care coordinator who will arrange all of your appointments. A few of the services provided include:

• Lab tests
• Inpatient hospital care
• Prescriptions
• Vaccines
• Durable medical equipment (oxygen monitors, walkers, etc.)
• Ambulance transportation
• Emergency room visits
• Mental health services

Every I-SNP must create a detailed Model of Care (MOC) that has to be approved by the Centers for Medicare and Medicaid Services (CMS) before it is offered to beneficiaries. The MOC outlines how enrollees will receive care. This process helps to ensure the plan gives a personalized, proactive approach to healthcare.

I-SNP Enrollment Periods

You can enroll in an I-SNP as soon as you have enrolled in Parts A and B (usually around your 65th birthday) or at any time of the year if you meet the qualifying conditions. You can also switch to an I-SNP during Medicare’s Annual Election Period (AEP). The same is true for disenrolling in an I-SNP. If you no longer require the care offered by an institutionalized setting, you’ll be given a Special Enrollment Period (SEP) that will allow you to change to a different Medicare Advantage plan.

Not everyone has access to an I-SNP. Medicare Advantage plans are based on counties and zip codes, which means urban areas often have more choices than rural areas do. You can only enroll in a Medicare Advantage plan that is offered in your residential zip code.