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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $0.60. You must continue to pay paying your reduced 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 $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) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs. Once your total drug costs reach $2000, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners North Carolina Community Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services require a 20% coinsurance, including outpatient services, partial hospitalization, ambulance, emergency services, primary care, preventive services, hearing, vision, dental, dialysis, medical equipment, and diagnostic services. The plan also covers home health services, with no copay or coinsurance, and covers Medicare-covered preventive services with no copay. The plan includes additional coverage for specific services. It covers ambulance and transportation services, with 14 one-way trips per year via rideshare, bus/subway, and medical transport. It also offers hearing exams, hearing aids, eye exams, and eyewear. Dental services are covered, with up to $3,000 per year for other dental services. Finally, the plan includes coverage for home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, though the specific cost-sharing details, such as copay, are not provided in the snippet. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance. Ambulatory Surgical Center (ASC) services, and outpatient substance abuse services have a minimum 20% and maximum 20% coinsurance. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners North Carolina Community Plan (HMO I-SNP) with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are partially covered, with 14 one-way trips per year available via rideshare services, bus/subway, medical transport, and other methods.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, but there is no copay; the coinsurance for Medicare-covered benefits is waived if admitted to the hospital within 24 hours. Urgently Needed Services are also covered with a 20% coinsurance and no copay, but Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Provider Partners North Carolina Community Plan (HMO I-SNP) covers primary care physician services, occupational therapy, and physical therapy and speech-language pathology services. Chiropractic services have a 20% coinsurance for routine care, while physician specialist services, mental health specialty services, additional telehealth benefits, and opioid treatment program services have a 20% coinsurance. Podiatry services have a 20% coinsurance for routine foot care, with a limit of 6 visits per year. Other health care professional services have a coinsurance between 0% and 20%. Individual and group sessions for psychiatric services have a 20% coinsurance.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams with 20% coinsurance, and kidney disease education services with 20% coinsurance. Additional preventive services, such as health education, are not covered, while other services, like glaucoma screening, have a 20% coinsurance.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20%, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (4 every two years). Prescription hearing aids are covered, including Inner Ear and Outer Ear, with a maximum benefit of $2000 every two years, but Prescription Hearing Aids (all types) and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear; routine eye exams have a 20% coinsurance, and are limited to one visit every year. Eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, is covered with a 20% coinsurance and a combined maximum of $300 per year, but eyeglasses frames and lenses are not covered.
Dental Services See details
The Provider Partners North Carolina Community Plan (HMO I-SNP) covers dental services, with a 20% coinsurance for Medicare Dental Services, and up to $3,000 per year for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered. Adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners North Carolina Community Plan (HMO I-SNP). This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment benefits include a 20% coinsurance for both Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. 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. You will pay coinsurance for diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, with a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Provider Partners North Carolina Community Plan (HMO I-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners North Carolina Community Plan (HMO I-SNP). This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months. Acupuncture, Meal Benefit, 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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