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Provider Partners Indiana Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Indiana 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 Indiana Advantage Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Indiana 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 Indiana (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Provider Partners Indiana 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 Indiana 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 Indiana 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 Indiana Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. 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:
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Drug Coverage
The Provider Partners Indiana Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. Once the deductible is met, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. After this point, you enter the catastrophic coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $49.60. In the catastrophic coverage phase, your out-of-pocket drug costs are $2000.00. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Provider Partners Indiana Advantage Plan (HMO I-SNP) offers a variety of benefits with varying cost-sharing. Many services, including primary care, outpatient, and emergency services, have a 20% coinsurance, while others, such as ambulance services and home health services, have no copay. This plan also offers additional benefits like dental, vision, and hearing services, with specific coverage details and maximums.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered and require prior authorization. The cost sharing for these services is the Medicare-defined cost share for tier 1, and some services are not covered, including Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a 20% coinsurance, observation services with a 20% coinsurance, ambulatory surgical center services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with a 20% coinsurance. The outpatient blood services benefit also waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Provider Partners Indiana Advantage Plan (HMO I-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay, but with a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are covered for 74 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Provider Partners Indiana Advantage Plan (HMO I-SNP) with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, except for routine care which is not covered. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no coinsurance.
Preventive Services See details
The Provider Partners Indiana Advantage Plan (HMO I-SNP) covers preventive services, including Medicare-covered services with no copay, and an annual physical exam with 20% coinsurance. Additional preventive services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a coinsurance of at most 20%, including one routine hearing exam per year and up to four fitting/evaluation visits for hearing aids every two years. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are covered, and there is a $2,000 plan maximum every two years for hearing aids, but 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 limited to one visit per year. Eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, also has a 20% coinsurance, with a combined maximum benefit of $150 per year, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0% to 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0% to 20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Indiana Advantage Plan (HMO I-SNP), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with 20% coinsurance for Medicare-covered Diabetic Supplies and 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 under this plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while all other diagnostic and radiological services have no copay and an unspecified coinsurance.
Home Health Services See details
Home Health Services are covered by the Provider Partners Indiana Advantage Plan (HMO I-SNP) with no copay and no coinsurance, but authorization is required. 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 Indiana Advantage Plan (HMO I-SNP). This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation 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 for this benefit.
Other Services See details
The Provider Partners Indiana Advantage Plan (HMO I-SNP) covers Over-the-Counter (OTC) Items with a maximum benefit of $75.00 every three months; however, 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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