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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 2026, 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 2026.
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.
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 $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) features an annual prescription drug deductible of $615. Before the plan begins to cover its share of your medication costs, you must pay this deductible amount out-of-pocket. Specific drug tier details, including exact copayments and coinsurance percentages for different medication levels, are not available for this plan. To determine how your specific prescriptions are covered and estimate your total costs, you should consult the plan's comprehensive formulary.
Additional Benefits
The Provider Partners Pennsylvania Community Plan (HMO I-SNP) provides comprehensive medical coverage where many outpatient, diagnostic, specialist, and emergency services feature no copay and a standard 20% coinsurance. Primary care visits require low copays up to $10, while inpatient hospital stays and skilled nursing facility care are subject to Medicare-defined copays with no coinsurance. Additionally, home health services are fully covered with no copay and no coinsurance, though prior authorization is required for many medical and hospital services. This plan also features robust supplemental benefits, including up to $3,000 annually for preventive and comprehensive dental care, and up to $2,000 every two years for prescription hearing aids with no copays or coinsurance. Vision care includes up to $300 annually for eyewear with a 20% coinsurance, and members receive up to 28 one-way transportation trips per year to health-related locations with no copay or coinsurance. An over-the-counter allowance of $150 every three months is also provided with no copay or coinsurance to help cover everyday health needs.
Inpatient Hospital See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) provides partially covered inpatient acute and psychiatric hospital services with no coinsurance and Medicare-defined copays, requiring prior authorization. Additional days, non-Medicare-covered stays, and acute care upgrades are not covered under this plan.
Outpatient Services See details
Outpatient services covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP) require no copayments but are subject to a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Provider Partners Pennsylvania Community 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 also covered with no copay or coinsurance, limited to 28 one-way trips per year.
Emergency Services See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers emergency services with a 20% coinsurance (up to $100 per visit) and no copay, and urgently needed services with a 20% coinsurance (up to $45 per visit) and no copay. Regarding worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary care services under the Provider Partners Pennsylvania Community Plan (HMO I-SNP) are covered with copays ranging from no copay to $10 and coinsurance from no coinsurance up to 20%, although chiropractic services are not covered. Specifically, primary care physician, occupational, and physical therapy services require a $10 copay and no coinsurance, while specialist visits, mental health, psychiatric, and telehealth services feature no copay and 20% coinsurance.
Preventive Services See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training, with no copay and a 20% coinsurance. While some additional preventive services are covered, sub-services such as fitness benefits, health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Provider Partners Pennsylvania Community Plan (HMO I-SNP), which offers hearing exams with no deductible, no copay, and a 20% coinsurance for routine visits. Covered prescription hearing aids feature no copay and no coinsurance up to a $2,000 maximum benefit every two years, while OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses. The plan provides up to $300 annually for covered contact lenses, eyeglass lenses, and eyeglass frames, though upgrades, eyeglasses (lenses and frames), and other eye exam services are not covered.
Dental Services See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) partially covers dental services, including Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental services are covered up to $3,000 annually with no copay and no coinsurance, though adjunctive general services are not covered.
Home Infusion bundled Services See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copay and a 20% coinsurance for diagnostic procedures, lab services, radiological services, and outpatient X-rays. Prior authorization is required for diagnostic services.
Home Health Services See details
Home Health Services are covered under the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by the Provider Partners Pennsylvania Community Plan (HMO I-SNP) with no coinsurance and Medicare-defined copayments, subject to prior authorization. The plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Provider Partners Pennsylvania Community Plan (HMO I-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $150 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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