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Provider Partners Pennsylvania Essential Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Pennsylvania Essential 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 Essential Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Pennsylvania Essential 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 and 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 Essential 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 Essential 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 Essential 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 Essential 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 Essential 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 medications before the plan begins to pay its share. Specific details regarding prescription drug tiers, copays, and coinsurance are not currently available for this plan. To determine how your specific medications are covered and calculate your expected costs, you should review the plan's formulary or contact the provider directly.
Additional Benefits
The Provider Partners Pennsylvania Essential Plan (HMO I-SNP) offers comprehensive healthcare coverage where most routine and outpatient services feature no copays and a standard 20% coinsurance. This cost-sharing structure applies to primary care, specialist visits, outpatient hospital services, diagnostics, and medical equipment. For inpatient hospital stays, Medicare-defined deductibles and copayments apply with no coinsurance, while skilled nursing facility care and home health services are covered with no copay and no coinsurance. In addition to core medical care, this plan provides valuable supplemental benefits to help lower your out-of-pocket costs. Members benefit from no copays and no coinsurance for preventive and comprehensive dental up to a $3,000 annual limit, prescription hearing aids up to $2,000 every two years, and up to 50 one-way routine transportation trips per year. You also receive a $120 over-the-counter allowance every three months, alongside up to $300 annually for eyewear with no copay and a 20% coinsurance for routine vision exams.
Inpatient Hospital See details
Inpatient hospital care is covered by the Provider Partners Pennsylvania Essential Plan (HMO I-SNP) with no coinsurance, though Medicare-defined copayments and deductibles apply and prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered for acute or psychiatric hospitalizations.
Outpatient Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copays and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Provider Partners Pennsylvania Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 50 one-way trips per year to any health-related location, though plan-approved health-related locations are not covered.
Emergency Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers emergency services with a 20% coinsurance up to $100 and no copay, and urgently needed services with a 20% coinsurance up to $40 and no copay. For 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
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers primary care, specialist, therapy, telehealth, and routine podiatry services with no copay and a 20% coinsurance, with podiatry limited to four annual visits. Some chiropractic services are covered, but routine and other chiropractic services are not covered. Other health professional services feature no copay and between no coinsurance and 20% coinsurance.
Preventive Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers preventive services with no copay, though a 20% coinsurance applies to annual physical exams, kidney disease education, and other screenings like glaucoma and diabetes self-management. Additional preventive services, such as fitness benefits, health education, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are partially covered by the Provider Partners Pennsylvania Essential Plan (HMO I-SNP), offering routine hearing exams with no copay and a 20% coinsurance. Prescription hearing aids (inner, outer, and over-the-ear) are covered with no copay and no coinsurance up to a $2,000 maximum limit every two years, while over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers vision services with no deductibles, no copays, and a 20% coinsurance for routine eye exams (limited to one per year) and contact lenses. Covered eyewear, which includes contact lenses, eyeglass lenses, and eyeglass frames, is limited to a $300 combined maximum benefit per year, while other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) offers partially covered dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, and preventive and comprehensive dental up to a $3,000 annual limit with no copay and no coinsurance. Most dental services are covered under this plan, but adjunctive general services are not covered.
Home Infusion bundled Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Pennsylvania Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Pennsylvania Essential 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, but the plan does not restrict services to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers diagnostic and radiological services with no copays and a 20% coinsurance. This coverage includes Medicare-covered lab services, diagnostic procedures, X-rays, and therapeutic or diagnostic radiological services, with prior authorization required for diagnostic services.
Home Health Services See details
Home Health Services are covered under the Provider Partners Pennsylvania Essential Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) covers Cardiac Rehabilitation Services with no copay and a 20% coinsurance, requiring prior authorization. While some services are covered, specific programs including 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
Skilled Nursing Facility (SNF) services are covered by the Provider Partners Pennsylvania Essential Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, though the plan does allow for SNF admission without a prior three-day inpatient hospital stay.
Other Services See details
Provider Partners Pennsylvania Essential Plan (HMO I-SNP) partially covers other services, offering an over-the-counter (OTC) benefit of $120 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered.
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