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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 2025, 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 2025.
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 $48.40. 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 Pennsylvania Advantage Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After the deductible, you will pay the costs associated with each drug tier. Once your total drug costs reach $2,000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services, including outpatient, emergency, and preventive services, have a 20% coinsurance. Some services, like primary care, vision exams, and home health services, have no copay. This plan provides coverage for hearing exams, vision services, and dental services, often with a coinsurance. It also covers home infusion, dialysis, medical equipment, diagnostic services, and skilled nursing facilities with coinsurance. The plan offers an OTC benefit, and there are some services that are not covered, like cardiac rehabilitation.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered, but specific services like Additional Days, Non-Medicare-covered Stays, and Upgrades are not covered. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a 20% coinsurance. Outpatient blood services have a 20% coinsurance, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) with prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance; transportation services to any health-related location are covered, offering 38 one-way trips per year. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and Urgently Needed Services are covered with a 20% coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) covers Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services with varying coinsurance amounts. Occupational Therapy Services are covered with no copay and no coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with 20% coinsurance, and kidney disease education services with 20% coinsurance. Other preventive services, such as glaucoma screenings, digital rectal exams, and EKG following Welcome Visit, are covered with 20% coinsurance, while services such as health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20%, and routine hearing exams are limited to 1 per year. Fitting/evaluation for hearing aids is covered, limited to 4 visits every two years. Prescription hearing aids are partially covered, with a maximum benefit of $2000 every two years, but not for all types of hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and routine eye exams with no coinsurance. Eyewear benefits are partially covered, with contact lenses covered with a 20% coinsurance, eyeglass lenses and frames 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 an annual maximum benefit of $3,000 for Other Dental Services. Specific services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are limited to one visit per year. Restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are covered without limit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP). The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with 20% coinsurance, and no copay. Durable Medical Equipment for use outside the home is not covered.
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 for diagnostic and radiological services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
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, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners Pennsylvania Advantage Plan (HMO I-SNP). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
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 of $95.00 every three months; however, acupuncture, meal benefits, 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.
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