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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 2026, 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 2026.
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 $38.40. 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:
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Drug Coverage
The Provider Partners Indiana Advantage Plan (HMO I-SNP) has an annual prescription drug deductible of $615. You will need to pay this deductible amount out-of-pocket before the plan begins to pay its share for your covered prescription medications. Specific drug coverage tier details, including individual copayments and coinsurance amounts, are not available for this plan. To determine how your specific medications are covered and calculate your expected costs, you should consult the plan's comprehensive formulary list.
Additional Benefits
The Provider Partners Indiana Advantage Plan (HMO I-SNP) offers comprehensive healthcare coverage where most medical services, including primary care, specialist visits, outpatient procedures, and emergency care, require no copay and a standard 20% coinsurance. Additionally, inpatient hospital stays are subject to Medicare-defined copays and deductibles with no coinsurance. Highly valued support services such as physical therapy, skilled nursing facility care, and home health services are fully covered with no copay and no coinsurance, though prior authorization is often required. This plan also features robust supplemental benefits, including up to 74 one-way transportation trips per year and a $155 quarterly over-the-counter item allowance with no copay or coinsurance. Dental services are covered up to a $5,000 annual limit, while hearing aids are covered up to $2,000 every two years and vision hardware up to $300 annually, all with no copay. Routine dental, vision, and hearing exams are accessible with no copays, though a 20% coinsurance applies to vision and hearing exams.
Inpatient Hospital See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, subject to Medicare-defined copays and deductibles with prior authorization required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copays and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, while blood services have no deductible.
Partial Hospitalization See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. The plan also covers up to 74 one-way transportation trips per year to any health-related location with no copay and no coinsurance.
Emergency Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers emergency services with a 20% coinsurance (up to $100 per visit) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay. Coinsurance is waived if you are admitted to the hospital within 24 hours for emergencies or 3 days for urgent care, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers primary care, specialist, mental health, psychiatric, telehealth, and opioid services with no copay and 20% coinsurance, while chiropractic services are not covered. Occupational, physical, and speech therapy services are covered with no copay and no coinsurance, though prior authorization is required. Routine podiatry is also covered with no copay and 20% coinsurance for up to 12 visits per year.
Preventive Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers preventive services with no copay and 20% coinsurance for annual physicals, kidney disease education, and select screenings. While some additional preventive services are covered, specific benefits like fitness, health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) offers partially covered hearing services, featuring routine hearing exams with no copay and a 20% coinsurance. Inner, outer, and over-the-ear prescription hearing aids are covered with no copay and no coinsurance up to a $2,000 maximum every two years, while over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Provider Partners Indiana Advantage Plan (HMO I-SNP) with no copays, though a 20% coinsurance applies to routine eye exams (one per year) and contact lenses. A combined $300 annual maximum covers contact lenses, eyeglass lenses, and eyeglass frames, while other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) offers partial coverage for dental services, featuring a $5,000 annual maximum for non-Medicare benefits. Medicare-covered dental services require no copay and 20% coinsurance, while other preventive and comprehensive services have no copay and no coinsurance, with the exception of adjunctive general services which are not covered.
Home Infusion bundled Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Indiana Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Indiana Advantage 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.
Diagnostic and Radiological Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for diagnostic procedures, lab services, X-rays, and radiological services. Prior authorization is required for all diagnostic services, including outpatient tests and lab work.
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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) features some covered cardiac rehabilitation services with no copay and prior authorization required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Provider Partners Indiana Advantage Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered days are not covered.
Other Services See details
Provider Partners Indiana Advantage 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 $155 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone coverage are not covered under this plan.
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