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Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Pennsylvania 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 Pennsylvania Advantage Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Pennsylvania 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 PA East & West Borders. This plan received an overall rating of 2 out of 5 stars in 2026.
It's important to know that Provider Partners Pennsylvania 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 Pennsylvania 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 Pennsylvania 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 Pennsylvania Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 Pennsylvania 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. Specific details regarding drug coverage tiers, copayments, and coinsurance costs are not available for this plan. To fully understand your potential out-of-pocket expenses, it is recommended to contact the provider directly for their complete formulary and tier pricing.
Additional Benefits
The Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) offers comprehensive medical coverage, with many outpatient, specialist, emergency, and diagnostic services requiring a 20% coinsurance and no copay. Inpatient hospital stays are covered with no coinsurance and Medicare-defined copays, while home health and skilled nursing facility services feature no copay and no coinsurance. Therapy services, including physical and occupational therapy, are also covered with no copay and no coinsurance. For supplemental care, the plan features generous dental coverage up to a $3,000 annual maximum and hearing aid coverage up to $2,000 every two years, both with no copay and no coinsurance. Members also benefit from a $300 annual eyewear allowance, up to 48 free one-way transportation trips to health-related locations, and a $105 quarterly over-the-counter benefit. Routine vision exams are also covered with no copay and no coinsurance, helping members easily manage their essential wellness needs.
Inpatient Hospital See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) partially covers inpatient hospital services with no coinsurance and Medicare-defined copays, requiring prior authorization for acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical, substance abuse, and blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services.
Partial Hospitalization See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP), requiring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered, offering up to 48 one-way trips per year to any health-related location with no copay and no coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers emergency services and urgently needed services with a 20% coinsurance and no copay, with costs counting toward the plan-level deductible. Coinsurance is waived if you are admitted to the hospital within 24 hours for emergency care or 3 days for urgent care, but worldwide emergency services are not covered.
Primary Care See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers primary care, specialist, mental health, psychiatric, telehealth, and podiatry services with no copay and a 20% coinsurance, while chiropractic services are not covered. Occupational, physical, and speech-language therapy services are covered with no copay and no coinsurance, though prior authorization is required.
Preventive Services See details
Preventive services are partially covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP), offering annual physicals, kidney disease education, and select screenings with no copay and 20% coinsurance. However, additional preventive benefits such as fitness programs, health education, weight management, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) partially covers hearing services, featuring hearing exams with no copay and a 20% coinsurance for routine exams, alongside fitting evaluations. Covered prescription hearing aids have 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 covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no deductibles or copays, offering one annual routine eye exam with no coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $300 annual limit with no coinsurance for individual lenses and frames, and a 20% coinsurance for contact lenses, though upgrades and packaged eyeglasses are not covered.
Dental Services See details
Dental services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for Medicare-covered services, and no copay or coinsurance for other dental services up to a $3,000 annual maximum. The plan covers most preventive and comprehensive dental services, including exams, cleanings, and implants, but adjunctive general services are not covered.
Home Infusion bundled Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Related Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Provider Partners Pennsylvania 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, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for diagnostic tests, lab services, radiological services, and outpatient X-rays. Prior authorization is required for diagnostic procedures and lab services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) technically covers cardiac rehabilitation services with no copay and prior authorization required, meaning some services are covered. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required and a prior three-day inpatient hospital stay is not. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) partially covers Other Services, which includes a supplemental over-the-counter (OTC) benefit of up to $105 every three months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered under this plan.
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