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Provider Partners North Carolina Community 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 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 North Carolina Community Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners North Carolina 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 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 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 North Carolina 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 North Carolina 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 North Carolina 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 $3750.00 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 North Carolina Community Plan (HMO I-SNP) prescription drug coverage features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your prescription medications before the plan begins to cover its share of the costs. Detailed information regarding specific drug tiers, copayments, and coinsurance rates is currently unavailable for this plan. When evaluating this North Carolina Medicare Advantage plan, you should factor the $615 deductible into your yearly healthcare budget. To find out how your specific medications are covered under this plan, it is recommended to review the plan's formulary or contact the provider directly.
Additional Benefits
The Provider Partners North Carolina Community Plan (HMO I-SNP) offers comprehensive healthcare coverage with many services featuring no copayments. For primary care, physical therapy, and occupational therapy, members pay a low $10 copay with no coinsurance, while specialist visits, outpatient hospital services, and diagnostic tests generally require no copay and a 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are covered with no coinsurance, though Medicare-defined copays and deductibles apply. This plan also provides valuable supplemental benefits, including home health services with no copay and no coinsurance. Additionally, members can access routine dental care up to a $3,000 annual limit, prescription hearing aids up to a $2,000 maximum every two years, and a $300 annual eyewear allowance with no copays. Other key perks include up to 28 free one-way transportation trips per year and a $150 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers acute and psychiatric inpatient hospital services with no coinsurance, although Medicare-defined copays and deductibles apply and prior authorization is required. 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 Community Plan (HMO I-SNP) are covered with no copay, but are subject to a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is not waived upon hospital admission. Transportation benefits are partially covered with no copay and no coinsurance for up to 28 one-way trips per year to any health-related location, though trips to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency services are covered by the Provider Partners North Carolina Community Plan (HMO I-SNP) with a 20% coinsurance (up to $100 per visit) and no copay, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services also require a 20% coinsurance (up to $45 per visit) and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers primary care physician, occupational therapy, and physical therapy services with a $10 copay and no coinsurance. Specialist, mental health, psychiatric, and telehealth services are covered with no copay and 20% coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by Provider Partners North Carolina Community Plan (HMO I-SNP) with no copay, though a 20% coinsurance applies to annual physical exams, kidney disease education, and other screenings. While some additional preventive services are covered, sub-services such as health education, fitness benefits, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are partially covered by the Provider Partners North Carolina Community Plan (HMO I-SNP), as OTC hearing aids are not covered. Covered benefits include hearing exams with no copay (routine exams require a 20% coinsurance) and inner, outer, or over-the-ear prescription hearing aids with no copay and no coinsurance up to a $2,000 maximum every two years.
Vision Services See details
Provider Partners North Carolina Community Plan (HMO I-SNP) partially covers Vision Services with no deductible, no copays, and a 20% coinsurance for routine eye exams and contact lenses. This benefit provides up to a $300 annual allowance for covered eyewear, but excludes other eye exam services, upgrades, and eyeglasses (lenses and frames).
Dental Services See details
Dental Services are partially covered under the Provider Partners North Carolina Community Plan (HMO I-SNP), which features a $3,000 annual maximum benefit for preventive and comprehensive care. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered services—excluding adjunctive general services—are available with no copay and no coinsurance.
Home Infusion bundled Services See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners North Carolina Community Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Provider Partners North Carolina Community Plan (HMO I-SNP) with no copay and a 20% coinsurance for all lab services, diagnostic procedures, radiological services, and outpatient X-rays. Prior authorization is required for diagnostic services.
Home Health Services See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Provider Partners North Carolina Community Plan (HMO I-SNP) covers some cardiac rehabilitation services with no copay and prior authorization required, but standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by the Provider Partners North Carolina Community Plan (HMO I-SNP) with no coinsurance and Medicare-defined copays, though prior authorization is required and additional days beyond Medicare-covered care are not covered. This benefit allows for admission without a prior three-day inpatient hospital stay.
Other Services See details
Provider Partners North Carolina 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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