Institutional Special Needs Plan (I-SNP)
A Medicare Advantage plan for people who live in a nursing facility or need that level of care. The plan choice is yours; HICAP gives free, unbiased help.
A directory listing, not an eligibility decision.
UniHealth can identify a possible match, but the responsible program makes the final decision.
What to know
- Why it may fit
- Your circumstances can be checked against the program’s published guidelines.
- What to do next
- A Medicare plan for people who live in a nursing home. Some also serve people who need that care at home. Joining one is your choice.
- Who runs it
- CMS / contracted plans
What the program may consider
- Medicare Parts A and B
- Plan-defined institutional or equivalent level-of-care status
- I-SNP serves the facility or Santa Clara service area
- Facility, clinicians, medicines and total costs
How to get it
A Medicare plan for people who live in a nursing home. Some also serve people who need that care at home. Joining one is your choice.
Before you start
- You need this first Original Medicare. You need Medicare Part A and Part B, and you must live in the plan's area.
How to apply
Request to join a Medicare health or drug plan
Only the person or their legal representative can ask to join. The plan's own phone line and website also take requests.
The same application can also ask for Medicare Advantage, Chronic Condition Special Needs Plan (C-SNP), Dual Eligible Special Needs Plan (D-SNP / Medi-Medi) and Medicare Part D and other drug coverage.
- OnlineMedicare.gov plan finderSee the plans in your area. You can also ask to join a plan there.
- Phone1-800-MEDICARE: 1-800-633-4227
- PhoneHICAP free Medicare counseling: 1-800-434-0222Free, unbiased help with Medicare choices.
- PhoneSourcewise information line: (408) 350-3200Weekdays, 8 a.m. to 5 p.m. Ask for the program you need.
- Online formSourcewise HICAP counseling requestAsk for yourself or for someone else.
- In personHICAP counseling sitesSenior centers, libraries and community centers. Call the site or book online.
Getting help
You start this yourself
Only you can choose and join a plan. A guardian, or someone with legal power to make your health decisions, may join for you. Others can help, but the choice and the request must be yours. HICAP gives free, unbiased help.
Only you, or someone with legal authority for you, can sign.
What happens after you apply
You qualify if you live in a nursing home or a similar place. You must stay, or expect to stay, 90 days or more.
YouA helper can help with this
An assessment using the state's tool must show you need nursing-home level care.
Only for plans that serve people living at home
The stateOnly you can do this
While you live in a nursing home, you can join, switch, or leave a plan in any month. This lasts until 2 months after you move out.
YouA helper can help with this
You choose a plan and ask to join. Use Medicare.gov, call 1-800-MEDICARE, or contact the plan.
YouOnly you can do this
Your Medi-Cal plan may change to match. This happens when the same company also runs a Medi-Cal plan where you live.
If you also have Medi-Cal
The state
The plan confirms your stay or your level of care.
Your health plan
The plan mails you a letter. It confirms you are in and says when coverage starts.
Your health planWithin 10 days after Medicare accepts the request.
The plan mails your member card. Show it when you get care, and keep your Medicare card too.
Your health planOnly you can do this
Coverage starts the first day of the next month. If you joined before your Medicare started, it starts with your Medicare. If you joined October 15 to December 7, it starts January 1.
Your health plan
What only you can do
- Choose a plan yourself, or through your legal representative. HICAP can explain your options for free.
- Sign the plan form, or agree by phone or online.
- Take part in the care-level check if you live at home.
- How long it takes
- If you join before your Medicare starts, the plan starts when Medicare does. Otherwise it starts the first of the month after the plan gets your request. Changes made October 15 to December 7 start January 1.
- You are enrolled when
- You are enrolled when the plan's letter confirms your start date and you have its member card.
- To keep it
- You stay while you still meet the plan's rules. If you move out of the facility, you have until 2 months later to make other choices.
Can’t be combined with
- Medicare Supplement Insurance (Medigap). You cannot use a Medigap policy with this kind of plan.
- Program of All-Inclusive Care for the Elderly (PACE). Joining PACE ends this plan.
- Medicare GUIDE dementia care and caregiver respite. Joining this kind of plan ends GUIDE, Medicare's dementia care program.
Coming changes
- Starting January 4, 2027: Some people who are not citizens lose Medicare on January 4, 2027. Citizens and green card holders keep it. So do Cuban or Haitian entrants and some Pacific island residents. Social Security writes first to people who will lose it. Their plan ends too.
Choosing a Medicare plan is your decision. UniHealth does not choose, recommend, or enroll anyone in Medicare plans. For free, unbiased help, call HICAP at 1-800-434-0222.