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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 2026, 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 4 out of 5 stars in 2026.
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 $4.80. 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 $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:
Sign up for Provider Partners Texas Advantage Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners Texas Advantage Plan (HMO I-SNP) has an annual prescription drug deductible of $615. This means you must pay $615 out of pocket for your covered medications before your plan begins to cover its portion of the costs. Detailed information regarding specific drug tier copays and coinsurance is currently unavailable for this plan. When considering this Medicare Advantage plan, keep in mind how the yearly deductible will impact your overall prescription costs. For complete details on specific drug coverage and pricing, it is best to contact the plan directly to ensure your medications are covered.
Additional Benefits
The Provider Partners Texas Advantage Plan (HMO I-SNP) offers comprehensive medical coverage where most preventive, specialist, outpatient, and diagnostic services require no copay and a 20% coinsurance. Inpatient hospital stays are covered with Medicare-defined copays and no coinsurance, while home health care and skilled nursing facility services feature no copay and no coinsurance. The plan also provides robust supplemental benefits, including dental services up to a $5,000 annual limit and prescription hearing aids up to $2,000 every two years with no copay and no coinsurance. Additionally, members receive up to 18 free one-way transportation trips per year, a $150 annual eyewear allowance, and a $70 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Provider Partners Texas Advantage Plan (HMO I-SNP) inpatient hospital benefits cover acute and psychiatric stays with Medicare-defined copays and no coinsurance, though prior authorization is required. This coverage is partial, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered by the Provider Partners Texas Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services to any health-related location are covered with no copay and no coinsurance for up to 18 one-way trips per year, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers emergency services with a 20% coinsurance (up to $100 per visit) and no copay, which counts toward the plan-level deductible and is waived if admitted to the hospital within 24 hours. Urgently needed services also require a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners Texas Advantage Plan (HMO I-SNP) provides primary care, specialist, mental health, podiatry, and telehealth services with no copay and 20% coinsurance, while occupational, physical, and speech therapy services feature no copay and no coinsurance. Chiropractic benefits are technically covered with no copay and 20% coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by the Provider Partners Texas Advantage Plan (HMO I-SNP), offering Medicare-covered preventive care, annual physical exams, kidney disease education, and glaucoma screenings with no copay and a 20% coinsurance. However, additional benefits such as fitness programs, health education, and personal emergency response systems are not covered.
Hearing Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers annual routine hearing exams with no copay and 20% coinsurance, plus fitting evaluations with no copay. Prescription hearing aids for the inner, outer, and over-the-ear are covered with no copay and no coinsurance up to a $2,000 maximum every two years, while over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Provider Partners Texas Advantage Plan (HMO I-SNP) with no deductible and no copays for all covered services. Routine eye exams are covered once annually with no coinsurance, and eyewear is covered up to $150 per year with no coinsurance for eyeglass lenses and frames, but contact lenses require a 20% coinsurance. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) offers partially covered dental services with a $5,000 annual maximum and no copays for all covered benefits. Most covered services have no coinsurance, though Medicare-covered dental and other diagnostic dental services require a 20% coinsurance, while adjunctive general services and removable prosthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Provider Partners Texas Advantage Plan (HMO I-SNP) with no copay, subject to prior authorization. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
The Provider Partners Texas Advantage Plan (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers diagnostic and radiological services with no copayment and a 20% coinsurance for Medicare-covered lab services, diagnostic procedures, X-rays, and radiological services. Prior authorization is required for diagnostic services.
Home Health Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the Provider Partners Texas Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance, and prior authorization is required. While the benefit is technically covered, some services are covered but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
The Provider Partners Texas Advantage Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required and admission does not require a prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered under this plan.
Other Services See details
Provider Partners Texas Advantage Plan (HMO I-SNP) partially covers Other Services, providing Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum of $70 every three months. Acupuncture, meal benefits, and other additional services under this category are not covered by the plan.
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