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Provider Partners North Carolina Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners North Carolina 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 North Carolina Advantage Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners North Carolina 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 Select North Carolina Counties. The overall rating for this plan is not yet available for 2026.
It's important to know that Provider Partners North Carolina 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 North Carolina 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 North Carolina 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 North Carolina Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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:
Sign up for Provider Partners North Carolina Advantage Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) has an annual prescription drug deductible of $615. You must meet this deductible by paying for your medications out-of-pocket before your plan coverage kicks in. Detailed information regarding drug tiers, copays, and coinsurance is not currently available for this plan. For the most accurate cost estimates for your specific prescriptions, you should consult the plan's comprehensive formulary.
Additional Benefits
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) offers comprehensive healthcare coverage with no copays for inpatient hospital stays, home health, and skilled nursing care. Many outpatient services, specialist visits, diagnostic tests, and emergency care require no copay and a standard twenty percent coinsurance. Additionally, rehabilitation therapies like physical and speech therapy are covered with no copays or coinsurance. This plan also provides valuable supplemental benefits, including up to a five thousand dollar annual dental limit and a two thousand dollar hearing aid allowance with no copays. Members benefit from seventy free one-way transportation trips per year to health-related locations and a three hundred dollar quarterly allowance for over-the-counter items. Routine vision exams and contact lenses are covered with no copay and a twenty percent coinsurance.
Inpatient Hospital See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization and Medicare-defined cost shares apply. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Provider Partners North Carolina Advantage Plan (HMO I-SNP) are covered with no copay and a 20% coinsurance. This coverage includes outpatient hospital visits, ambulatory surgical center services, outpatient substance abuse therapy, and outpatient blood services, with prior authorization required for some services.
Partial Hospitalization See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 70 one-way trips per year to any health-related location with no copay and no coinsurance, while plan-approved health-related location transportation is not covered.
Emergency Services See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which both count toward the plan-level deductible. The coinsurance is capped at $100 per emergency visit (waived if admitted within 24 hours) and $40 per urgent care visit (waived if admitted within 3 days), while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers primary care, specialist, telehealth, psychiatric, mental health, 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 North Carolina Advantage Plan (HMO I-SNP), offering annual physicals, kidney disease education, and select screenings with no copay and 20% coinsurance. Additional preventive services—including fitness benefits, weight management, health education, and in-home safety assessments—are not covered.
Hearing Services See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) partially covers hearing services, offering routine exams with no copay and 20% coinsurance, and prescription hearing aids with no copay and no coinsurance up to a $2,000 limit every two years. Fitting and evaluations are covered, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Provider Partners North Carolina Advantage Plan (HMO I-SNP), excluding other eye exam services, complete eyeglasses, and upgrades. Covered benefits feature no copay and no deductible, with no coinsurance for eyeglass frames and lenses, but a 20% coinsurance applies to routine eye exams (limited to one yearly) and contact lenses up to a combined $300 annual maximum.
Dental Services See details
Dental services are partially covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP), which excludes adjunctive general services but offers up to a $5,000 annual limit for other preventive and comprehensive benefits. Covered Medicare-covered dental services require no copay and a 20% coinsurance, while all other covered dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance of no coinsurance up to 20%, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetic devices.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Provider Partners North Carolina Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for all diagnostic tests, lab services, X-rays, and radiological therapies. Prior authorization is required for diagnostic procedures and lab services.
Home Health Services See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and require prior authorization under the Provider Partners North Carolina Advantage Plan (HMO I-SNP). While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Provider Partners North Carolina Advantage Plan (HMO I-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows admission with less than a three-day inpatient hospital stay, additional days beyond standard Medicare-covered SNF days are not covered.
Other Services See details
Other services are partially covered by the Provider Partners North Carolina Advantage Plan (HMO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $300 every three months. Acupuncture and meal benefits are not covered under this plan.
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