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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 2025, 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 3.5 out of 5 stars in 2025.
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 $22.80. 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 $590.00 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 $9350.00 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) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs depending on the specific tier and pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $22.80.
Additional Benefits
The Provider Partners Illinois Advantage Plan (HMO I-SNP) offers a variety of benefits with a focus on outpatient and preventative services. Many services, like ambulance, emergency, and home health services have no copay. The plan also includes coverage for hearing, vision, and dental services. This plan has coinsurance requirements for many services, including outpatient services, primary care, and vision services. There is also a maximum benefit of $300 for eyewear and $3,000 for dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare covered stays, and upgrades for both are not covered. The plan's cost share is defined by Medicare, so check the plan details for copay information.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Outpatient Blood Services also have a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP), with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are not covered. Transportation services to any health-related location are covered for up to 54 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Provider Partners Illinois Advantage Plan (HMO I-SNP) with a 20% coinsurance, and no copay. Urgently Needed Services are also covered with a 20% coinsurance and no copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Under the Provider Partners Illinois Advantage Plan (HMO I-SNP), primary care physician services and physician specialist services are covered with a 20% coinsurance, while occupational therapy services, physical therapy and speech-language pathology services have no coinsurance. Chiropractic services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services with no copay. Annual physical exams have a 20% coinsurance. Additional preventive services such as Health Education, In-Home Safety Assessment, and others are not covered. Kidney Disease Education Services, Glaucoma Screening, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20%, Routine Hearing Exams once per year, and Fitting/Evaluation for Hearing Aid with 4 visits every two years. Prescription Hearing Aids have a maximum benefit of $2000 every two years, with Inner Ear and Outer Ear aids covered, and Over the Ear aids also covered, but all other Prescription Hearing Aids are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and eyewear. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered. There is a combined maximum plan benefit coverage of $300 for eyewear per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, with a limit of 2 visits per year. Restorative services, endodontics, periodontics, and prosthodontics, fixed are covered. Adjunctive general services, prosthodontics, removable, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The cost sharing for Medicare Part B Insulin Drugs includes a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered supplies and therapeutic shoes/inserts; Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP). All diagnostic services and radiological services have no copay, but require a coinsurance of at most 20% for procedures, tests, and lab services, as well as diagnostic, therapeutic, and outpatient x-ray services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP) with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners Illinois Advantage Plan (HMO I-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit coverage amount of $230 every three months, but does not cover Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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