Understanding Special Needs Plans
Laying a Solid Foundation | Lesson 8

I-SNP Eligibility and Enrollment

The last Special Needs Plan is the Institutional Special Needs Plan or I-SNP.

As we mentioned in the intro, these are the least sold of the three SNP options. Some of these plans may only be sold by the carrier, and the ones that are agent sold may not offer commission.

So, make sure you review your contracts to confirm if you can sell these plans and what commissions are offered on that plan.

There are also strict marketing guidelines in place pertaining to how these plans may be marketed and sold. The decision-maker at any facility that you are looking at should be consulted prior to making any plans to visit.

While they may not be the most popular, we still think it is important you know about them.

We’ll start with eligibility. To be eligible for an I-SNP, your client must have Medicare Parts A & B and live in the plan’s service area like the other plans we’ve discussed. However, they also must be institutionalized, which means they live in or are expected to live in a qualified facility for 90 days or longer.

These facilities include skilled nursing facilities, psychiatric hospitals, and long-term care hospitals, to name a few.

If a client meets these qualifications, they would be able to enroll in an I-SNP.

As we mentioned for the other Special Needs Plans, clients have the same enrollment opportunities as standard Medicare Advantage plans.

Institutionalized individuals will also be eligible for the Open Enrollment Period for Institutionalized individuals or the OEPI. This period begins when the client becomes institutionalized and continues until two months after the month the individual leaves the institution.

During this time, the individual can make an unlimited number of enrollment requests, but the Medicare Advantage plans do not have to accept enrollment requests during the OEPI.

At any time during the OEPI, the individual can also drop their Medicare Advantage plan to return to Original Medicare.

That covers the basics of the I-SNP product. Our hope is that as you come across these products, this module will help give you a baseline of information to get you started in that market!

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