A non-government entity
Provider Partners Texas Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Texas 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 Texas Advantage Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Texas 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 Texas (Partial). This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Provider Partners Texas 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 Texas 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 Texas 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 Texas Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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:
Sign up for Provider Partners Texas Advantage Plan (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Provider Partners Texas Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $18.30. During the initial coverage phase, after you pay your deductible, you will pay the costs for your drugs until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Texas Advantage Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services have a 20% coinsurance, including outpatient services, primary care, specialist visits, preventive services like annual physical exams, hearing and vision services, dental, and ambulance services. There is no copay for ambulance services. The plan also provides specific benefits like coverage for home health services with no copay, and diagnostic and radiological services with no copay. Additionally, the plan offers coverage for home infusion and dialysis services with varying coinsurance amounts, and covers durable medical equipment, and offers an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, but details on copays are available separately. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services are covered, with 20% coinsurance for Outpatient Hospital Services, Observation Services, and Outpatient Blood Services. Ambulatory Surgical Center Services and Outpatient Substance Abuse Services are covered, with a coinsurance of 20% for Individual and Group Sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Provider Partners Texas Advantage Plan (HMO I-SNP) with prior authorization required. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for all ambulance services with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are covered for 18 one-way trips per year, with no copay and no coinsurance, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance, while Worldwide Emergency Services are not covered. For emergency services, the coinsurance is waived if admitted to the hospital within 24 hours.
Primary Care See details
The Provider Partners Texas Advantage Plan (HMO I-SNP) offers primary care services with a 20% coinsurance, chiropractic services with a 20% coinsurance (excluding routine care), and occupational therapy services with no coinsurance or copay. The plan also covers physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with varying coinsurance amounts.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and services like an annual physical exam with 20% coinsurance. Additional preventive services are partially covered, but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services. The plan also covers kidney disease education services with a 20% coinsurance. Other preventive services are also covered, including glaucoma screening, barium enemas, digital rectal exams, and EKG following Welcome Visit with 20% coinsurance, while Diabetes Self-Management Training is covered without coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20%, as well as fitting and evaluation for hearing aids, with up to 4 visits every two years. Prescription hearing aids are partially covered, with inner ear, outer ear, and over-the-ear hearing aids covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no coinsurance. Eyewear has a 20% coinsurance, and contact lenses are covered. Eyeglass lenses and frames are covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services and other diagnostic dental services. Other dental services have a $5,000 maximum plan benefit coverage every year. Oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered once per year. Restorative services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are covered. Adjunctive general services and prosthodontics (removable) are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Texas Advantage Plan (HMO I-SNP), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with a 20% coinsurance, Prosthetics/Medical Supplies and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies and Diabetic Supplies are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. For diagnostic procedures/tests and lab services, you pay at most 20% coinsurance, and for diagnostic, therapeutic, and outpatient x-ray services, you also pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Provider Partners Texas 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 Texas Advantage Plan (HMO I-SNP). While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare covered 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 $50.00 every three months. 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, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved