An Institutional Special Needs Plan (I-SNP) is a Medicare SNP for people needing an extended medical institution stay. To qualify, you need to show you require a residential stay for at least 3 months based on a confirmed diagnosis.

An I-SNP is one of three special needs plans available by Medicare Advantage, along with D-SNPs and C-SNPs. These plans often include special services tailored for people with chronic conditions.

It typically covers long-term care in places like nursing facilities, intermediate care centers for people with intellectual disabilities, or residential mental health facilities.

Read on to learn about I-SNPs, what they cover, who’s eligible, and possible costs.

Medicare Advantage (Part C) plans must offer the same coverage as Original Medicare (Parts A and B), but SNPs offer additional benefits.

For instance, while not all Part C plans include prescription drugs through Part D, all SNPs will include this coverage. They will also provide additional coverage on top of Original Medicare if you need extended residential stays of any kind.

Other special benefits may include food delivery, virtual doctor’s visits, and help with transportation.

That said, you’ll need to stay at a facility approved by the program. A full list of approved facilities is available on Medicare.gov.

Generally speaking, if you want to join an SNP, you need to be enrolled in Original Medicare. Anyone over the age of 65 qualifies for Medicare, as well as adults with certain chronic conditions.

Original Medicare includes Medicare Part A, which covers hospital stays, skilled nursing facility care, hospice care, and some home healthcare, as well as Medicare Part B (Medical Insurance). You also have to live in the plan’s designated service area.

You’ll need to show that you require a residential stay in an approved facility for a minimum of 90 days. Types of approved facilities include:

  • nursing homes
  • intermediate care facilities
  • skilled nursing facilities
  • rehabilitation hospitals
  • long-term care hospitals
  • swing-bed hospitals
  • psychiatric hospitals

SNPs are part of the Medicare Advantage program, and they’re typically offered by private insurance companies such as HMOs or PPOs.

This means that the cost of your I-SNP is going to depend on the specific insurance company administering your plan and your geographic area.

Some plans may charge you an extra premium on top of what you pay for Medicare Part B. But SNPs can’t charge higher rates than what is approved by Medicare for other services.

You may also be eligible for the Extra Help Program, which can help cover out-of-pocket costs for prescription drugs.

The three types of SNPs are similar in many ways. All three provide all Medicare services in one program, including hospitalization (Part A), medical care (Part B), and prescription drug coverage (Part D).

C-SNPs, however, only enroll individuals with severe or disabling chronic conditions, whereas D-SNPs are specifically designed for people who qualify for both Medicare and Medicaid.

Some people not living in a residential facility may still have complex medical needs that make it difficult to access all the care they need.

For this reason, institutional Equivalent Special Needs Plans (IE SNPs) are a special type of I-SNP intended for people who require a similar level of care to people who are institutionalized but able to remain at home.

Various medical conditions can create such complex needs. These include but aren’t limited to:

  • diabetes
  • congestive heart failure
  • heart disease
  • lung diseases
  • chronic kidney disease
  • depression and other mental health diagnoses
  • dementia
  • stroke
  • chronic pain
  • pressure ulcers
  • arthritis
  • malnutrition

Any condition that decreases your ability to function independently could qualify. That said, in order to qualify for an IE-SNP specifically, you’ll need to be assessed by an impartial representative of your state.

Medicare Advantage offers three types of special needs plans, including I-SNPs, D-SNPs, and C-SNPs. These plans offer customized services for people with chronic conditions.

An Institutional Special Needs Plan (I-SNP) is specifically for Medicare beneficiaries in need of an extended stay in a medical facility. To be eligible, you must have a confirmed diagnosis that requires a residential stay of at least 90 days.