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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 2025, 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 2025.
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 $51.20. 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 $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 North Carolina Advantage Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After the deductible is met, you'll pay the costs for your drugs based on the tier and the pharmacy you use until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the Catastrophic Coverage Phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you'll pay $51.20.
Additional Benefits
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) offers a range of benefits. This plan covers inpatient and outpatient services, as well as partial hospitalization and emergency services, all subject to a 20% coinsurance. Primary care services are also available with a 20% coinsurance, and preventive services are covered with no copay for Medicare-covered services. This plan also includes hearing, vision, and dental benefits. Hearing exams and hearing aids are covered, as well as routine eye exams and eyewear. Dental services include coverage for Medicare Dental Services, and other services up to $5,000 per year, and orthodontic services. Additionally, the plan covers home infusion bundled services, dialysis services, medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP), with prior authorization required. However, additional days, non-Medicare covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services have a 20% coinsurance, and the Outpatient Blood Services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP). The plan has a 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for both ground and air ambulance services with a 20% coinsurance; Transportation Services - Any Health-related Location is covered for 48 one-way trips per year, but Transportation Services - Plan Approved Health-related Location is not covered. There is no copay for Ambulance Services.
Emergency Services See details
Emergency Services are covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP), with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) offers primary care services with a 20% coinsurance, including chiropractic services with a 20% coinsurance, and occupational therapy services with no coinsurance or copay. Physician specialist services, mental health specialty services, additional telehealth benefits, psychiatric services, and opioid treatment program services are covered with a 20% coinsurance. Physical therapy and speech-language pathology services are covered with no coinsurance or copay. Podiatry services and other health care professional visits are covered with a coinsurance between 0% and 20%. Routine Chiropractic Care is not covered.
Preventive Services See details
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers preventive services, including Medicare-covered preventive services with no copay, and an annual physical exam with 20% coinsurance. Additional preventive services are partially covered, but do not include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20%, as well as routine hearing exams and fitting/evaluation for hearing aids. This plan also covers Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear. Prescription Hearing Aids (all types) and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. Routine eye exams have a 20% coinsurance, and are covered once per year. Eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, has a 20% coinsurance, 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. Other Dental Services have a maximum plan benefit of $5,000 per year, and cover oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all limited to one visit per year. Orthodontic Services are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. All other services have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners North Carolina Advantage Plan (HMO I-SNP) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment includes coverage for Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit, Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts, which are also subject to a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all 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 North Carolina Advantage Plan (HMO I-SNP) with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners North Carolina Advantage Plan (HMO I-SNP). The plan does not cover cardiac rehabilitation services, intensive cardiac rehabilitation services, pulmonary rehabilitation services, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, though the plan does not provide SNF services as a supplemental benefit under Part C. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Provider Partners North Carolina Advantage Plan (HMO I-SNP) covers Over-the-Counter (OTC) Items, with a maximum benefit of $210.00 every three months. 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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