What is an I-SNP? 

According to the Centers for Medicare & Medicaid Services, an Institutional Special Needs Plan (I-SNP) is a type of Medicare Advantage plan geared for a person who has special health care requirements. Unlike typical Medicare Advantage plans, I-SNPs provide specialized care to eligible enrollees who live in specific types of institutions, or for those who need a certain level of medical care. 

An Institutional Special Needs Plan covers all services and treatments required to manage the health condition of the beneficiary, their prescription drugs, durable medical equipment, and rehabilitation services. It also ensures access to teams of health care professionals who specialize in providing care to patients with certain medical and health care needs.  

I-SNPs cover all health care services included in Original Medicare Parts A (hospital insurance) and B (medical insurance) as well as additional benefits like dental, vision, and hearing care. Having access to this comprehensive coverage can help reduce costs for enrollees while guaranteeing that they’re getting the health care services they need. 

Who is eligible for enrollment in an Institutional Special Needs Plan?

You can enroll in an I-SNP if you meet all the following criteria:

1. You must be enrolled in Original Medicare Parts A and B.
2. You must live in the service area covered by the I-SNP you enroll in. 
3. You must currently require, or be expected to require soon, long-term care in an institutional setting for a minimum of 90 days. Accepted institutions include skilled nursing facilities, nursing homes, intermediate care facilities for people with intellectual disabilities, or inpatient psychiatric facilities.

When can you enroll in an I-SNP? 

When you’re certain that you’re eligible for enrollment in an I-SNP, you can do so any time during the year. You don’t need a Special Enrollment Period (SEP). If your eligibility for the I-SNP ends, Medicare will grant you a Special Enrollment Period lasting two months. During this period, you can return to Original Medicare or a regular Medicare Advantage (Part C) plan. 

What benefits do I-SNPs include? 

If you’re eligible for enrollment in an Institutional Special Needs Plan, your coverage should include the following benefits:

• Coverage for medical services like doctor’s visits, hospital stays, and medically necessary treatment 
• Prescription drugs prescribed by your health care providers

• Skilled nursing care provided by licensed nurses
• Physical and occupational therapy, and speech-language pathology services
• Assistance with custodial care needs
• Durable medical equipment 

How much does an I-SNP cost? 

The out-of-pocket costs you have as an enrollee in an Institutional Special Needs Plan depend on whether you qualify for dual eligibility and what network restrictions your plan has. 

If you qualify for both Medicare and Medicaid, Medicaid might cover a portion, or all, of your I-SNP costs like premiums, deductibles, coinsurance, and copayments, depending on the plan you can enroll in. 

Certain I-SNPs require that you use in-network health care providers and medical facilities for your medical services to be eligible for coverage. These restrictions don’t include emergency or out-of-network urgent care. On the other hand, you may be able to enroll in an I-SNP that includes out-of-network coverage at a higher monthly cost. 

When you enroll in an I-SNP, you should go over the details of your coverage, so you know what to expect regarding costs, benefits, and network restrictions.