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Provider Partners Illinois Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Illinois Advantage Plan (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Provider Partners Illinois Advantage Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Illinois Advantage Plan (HMO I-SNP) is a HMO I-SNP plan offered by Rifkin Managed Care Holding, LLC available for enrollment in 2025 to people living in Illinois (partial). This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Provider Partners Illinois Advantage Plan (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Provider Partners Illinois Advantage Plan (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Provider Partners Illinois Advantage Plan (HMO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Provider Partners Illinois Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Provider Partners Illinois Advantage Plan (HMO I-SNP) features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Because specific drug tier copayments and coinsurance details are not available, it is important to verify how your specific medications are covered before enrolling. Understanding your prescription drug costs is vital when choosing a Medicare Advantage plan. Be sure to review this plan's formulary to ensure your necessary prescriptions are covered and to determine your potential out-of-pocket expenses once the $615 deductible is met.
Additional Benefits
The Provider Partners Illinois Advantage Plan (HMO I-SNP) offers comprehensive medical coverage featuring no copays and a standard 20% coinsurance for outpatient hospital services, doctor visits, emergency care, and diagnostic testing. Inpatient hospital stays require no coinsurance and adhere to Medicare-defined cost-sharing, while skilled nursing facility stays and home health services are covered with no copay and no coinsurance. Prior authorization is required for several key benefits, including inpatient care, therapies, and durable medical equipment. This plan also includes robust supplemental benefits, such as up to $3,000 in annual dental coverage and up to $2,000 every two years for hearing aids with no copay and no coinsurance. Members can also take advantage of no copay and no coinsurance for up to 74 one-way health-related transportation trips per year and a $255 quarterly over-the-counter allowance. Vision care is covered with no copay and a 20% coinsurance, which includes a routine annual eye exam and up to $300 for eyewear.
Inpatient Hospital See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance and Medicare-defined cost-sharing, subject to prior authorization. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. The plan also covers transportation to any health-related location for up to 74 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Emergency services and urgently needed services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with a 20% coinsurance (waived upon hospital admission), no copay, and cost-sharing that applies to the plan deductible. While some worldwide emergency services are covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers primary care, specialist, mental health, psychiatric, and podiatry services with no copay and 20% coinsurance, while chiropractic services are not covered. Occupational, physical, and speech therapy services are covered with no copay and no coinsurance, subject to prior authorization.
Preventive Services See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers preventive services with no copay, though an annual physical exam, kidney disease education, glaucoma screenings, and diabetes self-management training require a 20% coinsurance. Although some services are covered, additional benefits like fitness programs, health education, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP), featuring routine hearing exams with no copay and 20% coinsurance, alongside fitting evaluations with no copay and no coinsurance. Prescription hearing aids (inner, outer, and over-the-ear) are covered with no copay and no coinsurance up to a $2,000 maximum every two years, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP), featuring no copay and a 20% coinsurance for covered services, which include one routine eye exam per year and eyewear up to a $300 annual limit. While contact lenses, eyeglass lenses, and eyeglass frames are covered, other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP), which offers up to $3,000 in annual coverage for preventive and comprehensive dental care with no copay and no coinsurance. Medicare-covered dental services are available with no copay and a 20% coinsurance, though adjunctive general services, removable prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin requiring a $35 copay and no deductible.
Dialysis Services See details
Dialysis services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays. Prior authorization is required for diagnostic services.
Home Health Services See details
Home Health Services are covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. Admission does not require a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Provider Partners Illinois Advantage Plan (HMO I-SNP) partially covers Other Services, which includes an over-the-counter (OTC) benefit of up to $255 every three months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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