Institutional Special Needs Plan (I-SPN) is a type of Medicare Advantage plan and is designed for people who need long-term care. Specifically, it is designed for people who need care receiving in institutions like skilled nursing facilities, long-term care facilities, inpatient psychiatric facilities, and intermediate care facilities. You can enroll in this type of plan if you meet certain criteria.
Institutional Special Needs Plan Coverage
Medicare Advantage plans must cover all same benefits as Original Medicare (Part A and B). Therefore, an Institutional Special Needs plan covers inpatient and outpatient services, medically necessary services, and preventive care. Alongside that, these plans also include treatments like vaccines, durable medical equipment, medication prescriptions, lab tests, inpatient hospital care, emergency room, clinical research, mental health services, and ambulance transportation services. 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.
When Am I Eligible For Institutional Needs Plan?
To be eligible for Institutional Special Needs plans, you need to have Original Medicare which is consisted of Parts A and B. But, to consider your eligibility for this plan you must need that level of care that provides you with a setting in institutions that give long-term care. You need to be institutionalized for more than 90 days. Be careful, that to get this plan, you must also live in a country or local community where the institution you need to be settled in has the authorization to operate.
Institutional Special Needs Plan Costs
Because this is a Medicare Advantage plan, it is sold by private insurance companies. This means that those companies can have their own terms and conditions, as well as payment rates. Plan costs may differ from plan to plan, and from company to company. However, beneficiaries are always responsible for paying Part B monthly premiums, but some plans may require to pay additional premiums alongside Part B. Also, some plans can have an annual deductible which beneficiaries are responsible to meet before their plan covers costs. Enrolees also may be responsible for out-of-pocket costs like copayments and coinsurance for medical services.
Institutional Equivalent Special Needs Plan
If you met the requirements for long-term care, that doesn’t mean you. have to stay in a specialized institution. If you rather like to receive care in your home than in an authorized institution, you may qualify for an Institutional Equivalent Special Needs plan. You have to meet all the same requirements as qualifying for an Institutional Special Needs plan. This means that you must be enrolled in Original Medicare and have certification from your state that you need this type of care. Beneficiaries also can be eligible if they are living in group settings or assisted living residences. The main goal of this plan is that enrollees can get needed care which is face-to-face, and that can reduce the need of going to emergency rooms and hospitalization.
Other Available Special Needs Plans
Special Needs plans are types of Medicare Advantage plans that combine all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D) but are only available to those beneficiaries who have an additional qualifying condition. Beside Institutional Special Needs plans, there are other types like Qualifying Chronic Conditions plans, and Dual Eligible Special Needs plans.
Chronic Conditions Special Needs Plans
Like other Medicare Advantage (Part C) plans, C-SNPs offer you the same covered services as the hospital and medical insurance under Original Medicare (Part A and Part B). Chronic Condition Special Needs Plans contract with a network of healthcare providers who can treat your chronic condition. This often includes specialists in the area of your state, which is one of the main draws of these plans.
With a Chronic Condition SNP, you need a primary care doctor or care coordinator who can help manage your healthcare. Having one of these professionals guide your care will ensure you receive the specialized treatments you need.
To qualify for a New Jersey C-SNP, you must have a chronic condition defined by Medicare and the Center for Medicare and Medicaid Services (CMS). These conditions include chronic alcohol and other drug dependence, autoimmune disorders, cancer, cardiovascular discords, chronic heart failure, dementia, end-stage liver disease, diabetes mellitus, end-stage renal disease, HIV/ AIDS, stroke, etc.
Dual Eligible Special Needs Plan
Dual special needs plans are designed for people who need to use some extra help. It can be because of income, disabilities, age, and/or health conditions. Enrolling in a D-SNP must be eligible for Medicare and Medicaid coverage. Different states vary in their requirements for which Medicaid programs you must participate in meeting the eligibility criteria for these Special Needs Plans.
If you need to know more. be out Special Needs Medicare Advantage plans, you can check coverage options in New Jersey here. Also, if you aren’t sure what SNP MA plans are the right fit for you and need more information about benefits, payment rates, and coverage you can contact Jersey Insurance Solutions. Our Medicare agents are happy to help!
Craig W. Hansen is an insurance professional and co-founder of William & Michael Advisor Group LLC and Jersey Insurance Solutions. Craig has served his clients in many facets of the insurance industry, always with the same goal: excellence in service while building solid, long-term, lasting relationships. With over a decade of experience in the insurance benefits industry, Craig’s clients know they can call on him anytime and receive platinum service with a smile.
