Institutional special needs plans (I-SNP) are specialized Medicare Advantage plans for people who live in a care facility for at least 90 days or those who live in the community and require the care that facilities can provide.
Medicare Advantage (Part C) offers special needs plans (SNPs) that provide benefits and services specifically for people who have severe chronic conditions, certain healthcare needs, or who also qualify for Medicaid.
There are three types of SNPs:
- Instituational SNP (I-SNP)
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
An I-SNP is a SNP where enrollment is limited to individuals with Medicare Advantage (Part C) plans who have had or are expected to need a level of care and services provided in:
- long-term care skilled nursing facilities
- nursing facilities
- intermediate care facility for individuals with intellectual disabilities
- inpatient psychiatric facility
In order to qualify for an I-SNP, a person must require this care for at least 90 days.
All Medicare Advantage plans must offer the same coverage as Original Medicare (parts A and B). This means these plans cover inpatient care, outpatient care, hospice care, some home healthcare, and preventive care.
While many Medicare Advantage plans offer prescription drug coverage (Part D), all SNP plans are required to include prescription drug coverage.
SNPs may also include additional benefits, such as a care manager to assess a person’s needs, provide supervision of their care, and advise on how best to manage health conditions. SNPs may offer coverage for dental, vision, and hearing. It is important to check the individual plan for additional benefits.
In order for a person to join an SNP, they must meet these requirements:
- have both Medicare Part A and Part B
- live within the plan’s service area
In order to be eligible for an I-SNP specifically, they must meet these requirements:
- living in the community but requiring the level of care a facility offers
- living in or expected to live in a facility for at least 90 days, including:
- nursing home
- intermediate care facility
- skilled nursing facility
- rehabilitation hospital
- long-term care hospital
- swing-bed hospital
- psychiatric hospital
- other facility that offers similar long-term healthcare services
An I-SNP, known as an institutional-equivalent special needs plan (IE-SNP), is for people who require a level of care provided by facilities but are able to remain living within the community.
This may include people with chronic conditions who require extra help in accessing care, managing medications, or using appropriate levels of care. Chronic conditions that may require an IE-SNP include:
- congestive heart failure
- diabetes
- chronic obstructive pulmonary disorder (COPD)
- cardiovascular diseases
- chronic kidney disease (CKD)
- depression
- dementia
- obesity
- any condition that impairs a person’s functional status
In order to qualify for an IE-SNP, a person will typically need an assessment by an impartial representative from their state.
An I-SNP is just one type of SNP. Each plan has its own requirements and additional coverage options.
C-SNP
C-SNPs are specialized plans for individuals with one or more severe or disabling chronic conditions. People who qualify for C-SNPs must have a high risk of hospitalization or adverse health outcomes.
Qualifying chronic conditions include:
- cancer
- certain autoimmune disorders
- chronic alcohol or substance dependence
- cardiovascular disorders
- diabetes
- chronic heart failure
- dementia
- end stage liver disease
- end stage renal disease (ESRD)
- HIV, including stage 3 HIV
- certain chronic lung disorders
- stroke
D-SNP
D-SNPs are plans specifically for people who are eligible for both Medicare and Medicaid. This is the only eligibility requirement for this type of plan.
D-SNPs offer help to coordinate a person’s Medicare and Medicaid benefits.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
SNPs are specialized Medicare Advantage plans that are designed for individuals with specific care needs or those who are eligible for both Medicare and Medicaid.
I-SNPs are plans for people who are living or are expected to live in a care facility for at least 90 days. I-SNPs can also be used for people who still live in the community but require the level of care available in a facility.