I-SNPs: Coverage for People in Senior Living Communities

For older adults who need support with everyday life, senior living communities often provide security, comfort and peace of mind. Residents can get help with essentials, such as meals, housekeeping and transportation—and participate in fun activities.

Many residents of senior living communities also have complex medical conditions. Families and staff typically work together to manage appointments, tests and treatments. But it can be challenging for everyone to ensure each resident’s needs are fully met.

If you or a loved one is in this situation, a Medicare Advantage (Part C) plan may be able to help.

What Are I-SNPs?

Institutional Special Needs Plans (I-SNPs) are Medicare Advantage plans designed for people living in community-based settings who have certain care needs. Often, that’s a long-term care setting, such as a skilled nursing facility.

Some I-SNPs are for people in other settings, such as assisted living and memory care communities. These plans are called Institutional Equivalent SNPs (IE-SNPs) because they serve people who require a skilled nursing facility level of care but choose to live elsewhere.

Here’s how I-SNPs work:

• Your plan covers all levels of care (primary, specialty, emergency, hospital), medical equipment, medications and more.
• You have a medical provider who visits you at least once a month and monitors your conditions and overall health.
• Your medical provider coordinates with your primary care doctor and facility staff to make sure you get the care you need on a timely basis.

The main benefit of these plans is that they’re highly personalized. You have a dedicated medical professional, and a care plan tailored to your needs. By tracking and managing care, I-SNPs can also make life easier for you and your family.

What to Look for in an I-SNP

Before choosing an I-SNP, it’s important to weigh all your options for coverage. That means comparing it with Original Medicare, Medicare Supplements and other Medicare Advantage plans.

I-SNPs offer a different model of care from other Medicare options. Features to look for include:

Multidisciplinary Team

The most effective way to manage care, especially for people who have significant medical needs, is with a team of experts from various fields. These medical professionals work together to manage the many aspects of care.

With SCAN’s combination I-SNP and IE-SNP plan, called SCAN Embrace, you have a dedicated team focused on your health and quality of life. Team members and their roles include:

• Doctors: Lead the team and oversee care
• Nurse practitioners: Visit you in your home, monitor your condition and coordinate medical services
• Behavioral health specialists (therapists and psychiatrists): Provide mental health services
• Pharmacists: Manage your medications
• Care managers: Assist with care coordination

Mobile Primary Care

With an I-SNP, you have a medical provider who comes to you. SCAN Embrace takes this a step further. With our plan, your provider takes care of your primary care needs and even some specialty care in the comfort of your home.

This proactive and hands-on approach helps identify and treat any issues that arise early. It also streamlines your care when fewer specialists are involved.

Robust Care Coordination

The I-SNP team’s first step is to work with you to understand your medical and nonmedical needs. This information helps your team:

• Develop a plan for how often to see you
• Identify other services you could benefit from

Under SCAN Embrace, for example, we see members as needed—which often turns out to be more than once a month. We also schedule appointments, arrange transportation and coordinate all your care. And with a limited number of members assigned to each team, your providers have time to focus on you.

24/7 Assistance

Medical issues can crop up at any time of day or night, leaving you wondering where to turn. For someone in senior living, this often means an unnecessary trip to the ER. An I-SNP should provide 24/7 assistance to assess and troubleshoot problems.

The SCAN Embrace team is available around the clock for medical advice. Our team reviews your symptoms and works with the staff at your community to plan your next steps.

Hospital Alternative Care

One goal of an I-SNP is to reduce emergency room visits and hospital stays. That’s also a goal for members and their families.

Instead of sending members to an emergency room, SCAN works with skilled nursing facilities to provide hospital-level care when appropriate. The skilled nursing facility can access your medical records and care team, which helps ensure prompt, high-level care. And, you can stay until your condition improves before returning home.

Extra Benefits

As Medicare Advantage plans, many I-SNPs offer supplemental benefits, such as vision, hearing and dental. Other benefits to look for that may be helpful for those in senior living communities include:

• In-home care after a hospital or nursing facility stay. SCAN’s Returning to Home benefit covers in-home care to help with tasks such as bathing and dressing.
• Over-the-counter (OTC) benefit that covers nonprescription items. From antacids and vitamins to sunscreen, SCAN’s quarterly OTC benefit gives you an allowance to spend on a wide range of products. And any unused allowance rolls over to the next quarter.
• Transportation benefit for rides to the doctor, dentist and pharmacy. The Transportation benefit through SCAN Embrace also includes a certain number of rides to use for non-medical destinations, such as your grocery store, senior center or health club.

How to Sign Up for an I-SNP

For most Medicare Advantage plans, you can only sign up during specific enrollment periods. But with an I-SNP, you can join at any time.

To qualify, you must have Medicare Part A and Part B and live in the plan’s service area. Before enrolling, you’ll also meet with a healthcare provider to check your eligibility. They look mainly at your ability to do things on your own, such as:

• Bathing and dressing
• Doing housework and laundry
• Preparing meals
• Taking medications

Learn More About SCAN Embrace

At SCAN, we want to help you stay healthy and independent for as long as possible. To find out more about SCAN Embrace and our other Medicare Advantage plans, use our online search tool. If SCAN Embrace is available in your area, you’ll find it listed among your plan options.

You can also contact us for assistance and support at:

• 1-800-559-3500 (TTY: 711) for current SCAN members
• (877) 452-5898 TTY: (888) SCAN-TTY for nonmembers