Needing specialized care in a facility isn’t anyone’s idea of a good time, but there are circumstances that require it. In some cases, you may need an extended stay to help treat or recover from an illness. Without coverage, the costs for a stay like this can quickly add up. However, if you’re expecting an extended stay at a care facility, you may fit the requirements for an Institutional Special Needs Plan (I-SNP). These special needs plans (SNPs) are specifically organized to help beneficiaries afford longer inpatient stays.
I-SNPs are special needs plans that center coverage around services at a qualified care facility. This can include skilled nursing facilities, nursing homes, intermediate care facilities, inpatient psychiatric facilities, or other forms of long-term care facilities.
While I-SNPs are Medicare Advantage plans, they must fulfill two conditions to qualify as special needs plans. First, there must be an approved method to determine institutional level of care based on state assessment tools. A determination method from the state where the I-SNP is authorized may also be used if that state doesn’t have tools already. The other condition is that this assessment must be administered by an independent third party. This third party may not be owned or controlled by the I-SNP and must have the relevant knowledge to accurately complete the assessment.
This may include preventive medicine, medications, and other services as part of your inpatient care.
I-SNPs must cover everything Original Medicare covers but may have additional benefits. In fact, I-SNPs satisfy many of the costs associated with your specific needs. This may include vaccines and preventive medicine, prescription medications associated with your care and treatment, durable medical equipment, mental health services, and other health care services you receive while under inpatient care. As part of your coverage, I-SNPs must also provide a model of care to the Centers for Medicare & Medicaid Services (CMS) that explains how the facility will meet your medical needs.
Not everyone who can enroll in a Medicare Advantage plan qualifies for an I-SNP. Luckily, they have a pretty low bar to qualify for enrollment compared to some other SNPs. Most of the time, you’ll become eligible for an I-SNP by requiring long term care at a facility for 90 days or more.
To become eligible for an I-SNP early, it must be determined that your case will require at least 90 days of care.
This isn’t the only way to receive coverage from an I-SNP, though. To become eligible early, it must be determined that your case will require at least 90 days of care through a needs-assessment. This assessment is pre-approved by CMS and takes a professional look at your situation to determine the level of care needed.
If you qualify for an I-SNP, enrolling in it is just like enrolling in another type of Medicare Advantage plan. You can contact the plan directly or by using a plan finder to explore your options.
Not everyone who requires long-term or specialized care stay in a qualified care facility. Many people are now choosing to remain in their homes. This doesn’t mean you no longer qualify for an I-SNP. Instead, you may be eligible for an Institutional Equivalent SNP (IE-SNP). This is a specific type of I-SNP for these special cases.
Once you’re declared eligible and enrolled, your plan should cover many of the services an I-SNP covers with a focus on preventive care.
Furthermore, to receive coverage from an IE-SNP, a beneficiary must undergo a needs-assessment to show that they require institutional level care. This assessment follows the same requirements as the I-SNP assessment, meaning it must use state assessment tools or an equivalent set and be conducted by an independent third party. Once you’re declared eligible and enrolled, your plan should take care of many of the services an I-SNP covers with a focus on preventive care that reduces the need for inpatient or emergency care.
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Whether you’re receiving institutional care at a specialized facility or in your own home, you may be eligible for a special needs plan if your condition requires it for an extended period of time. Enrolling in an I-SNP gives beneficiaries the opportunity to have many of these services covered so they can start focusing on getting better.