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Provider Partners Pennsylvania Community Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Pennsylvania Community 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 Community Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Pennsylvania Community 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 Community 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 Community 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 Community 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 Community Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.80. You must continue to pay paying your reduced 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 $2600.00 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 Community Plan (HMO I-SNP) has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will have no copay for your prescriptions. Once you meet the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Pennsylvania Community Plan (HMO I-SNP) offers a range of benefits with varying cost structures. Many services, such as primary care, home health, and diagnostic services, have no copay. However, many services have a coinsurance of 20%, including inpatient and outpatient services, specialist visits, hearing, vision, and dental care. The plan also includes coverage for specific services with limitations. These include hearing aids up to $2000 every two years, vision care with a $300 annual limit for eyewear, and dental services with a $3,000 annual maximum. Additionally, the plan provides an OTC benefit of $50 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered and require prior authorization. Additional days for Inpatient Hospital-Acute and Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while ambulatory surgical center services and outpatient substance abuse services have a minimum of 20% and a maximum of 20% coinsurance. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with prior authorization required. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
The Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers ambulance services with a 20% coinsurance for both ground and air ambulance services and no copay. Transportation Services are partially covered, with up to 14 one-way trips per year to any health-related location, but transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services are covered with no copay and no coinsurance. Chiropractic Services are covered with 20% coinsurance, but routine care is not covered. Physician Specialist Services, Additional Telehealth Benefits, and Mental Health Specialty Services have a 20% coinsurance. Podiatry Services have 20% coinsurance for routine foot care, limited to 4 visits per year. Other Health Care Professional services have a coinsurance between 0% and 20%, and Psychiatric Services and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive services, including Medicare-covered services, are covered by this plan. The plan covers annual physical exams with a 20% coinsurance. Other preventive services, such as Health Education, In-Home Safety Assessment, and others are not covered. Other services like Glaucoma Screening, Barium Enemas, and others are covered with a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20%, routine hearing exams limited to 1 per year, and fitting/evaluation for hearing aids limited to 4 every two years. Prescription hearing aids are covered up to a maximum of $2000 every two years, with inner ear, outer ear, and over-the-ear aids covered. Over-the-counter hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear, with a 20% coinsurance for both. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $300 per year; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance and other dental services with a $3,000 maximum benefit per year. Preventive and diagnostic services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with an annual limit of one visit. The plan also covers restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
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, with coinsurance between 0% and 20%. 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 under the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and also requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Supplies/Therapeutic Shoes/Inserts have a 20% coinsurance, and there is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Provider Partners Pennsylvania Community Plan (HMO I-SNP). There is no copay for diagnostic or radiological services, and coinsurance is at most 20% for diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the specific sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays. Prior authorization is required, and you will have a copay, with more information available in the plan details.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months, and 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.
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