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Provider Partners Indiana Community Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Indiana 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 Indiana Community Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Indiana 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 Indiana (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Provider Partners Indiana 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 Indiana 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 Indiana 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 Indiana 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 $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 Indiana Community Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the specific drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have reduced premium costs.
Additional Benefits
The Provider Partners Indiana Community Plan (HMO I-SNP) offers a wide range of benefits with varying cost-sharing. Many services, such as primary care, occupational therapy, home health, and ambulance services, have no copay. However, many services require coinsurance, including outpatient services, emergency services, hearing, vision, dental, and others, generally at 20%. This plan also provides coverage for home infusion, including prescription drugs with a $35 copay for some drugs, and offers additional benefits like over-the-counter items up to $50 every three months. While the plan covers many services, it's important to note that some services, such as cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the plan does not cover additional days for Inpatient Hospital-Acute or Psychiatric, non-Medicare-covered stays for Inpatient Hospital-Acute or Psychiatric, or upgrades for Inpatient Hospital-Acute. The copay for these services is not specified in this snippet.
Outpatient Services See details
Outpatient Services includes coverage for 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, while outpatient blood services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by the Provider Partners Indiana Community Plan (HMO I-SNP) with no copay, but with a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are covered, with 36 one-way trips per year, using rideshare services, bus/subway, medical transport, or other transportation methods. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services are covered, with a 20% coinsurance for emergency services and urgently needed services. Worldwide emergency services, including coverage, urgent coverage, and transportation, are not covered.
Primary Care See details
The Provider Partners Indiana Community Plan (HMO I-SNP) covers primary care physician services with no copay and no coinsurance, chiropractic services with 20% coinsurance (routine care not covered), occupational therapy services with no copay and no coinsurance, and physician specialist services with 20% coinsurance. The plan also covers mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits with 20% coinsurance, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services have a minimum and maximum coinsurance of 20%.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero-dollar preventive services. Annual physical exams have a 20% coinsurance, while other services like health education, in-home safety assessments, and more are not covered. Kidney disease education services and other preventive services, such as glaucoma screenings, digital rectal exams, and EKG following welcome visits, have a coinsurance between 20% and 20%.
Hearing Services See details
Hearing Services include hearing exams with a coinsurance of at most 20%, as well as coverage for routine hearing exams and fitting/evaluation for hearing aids. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are covered, but Prescription Hearing Aids (all types) and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with 20% coinsurance, and one routine eye exam per year. Eyewear is covered with 20% coinsurance and a combined maximum plan benefit of $300 per year, including contact lenses, eyeglass lenses, and eyeglass frames; however, 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for all covered drugs.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Indiana Community Plan (HMO I-SNP) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. For DME, there is a 20% coinsurance and authorization is required, but there is no copay; however, Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Provider Partners Indiana Community Plan (HMO I-SNP), including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. All services have no copay, but require coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Provider Partners Indiana Community 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 Community Plan (HMO I-SNP). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The Provider Partners Indiana Community Plan (HMO I-SNP) covers over-the-counter (OTC) items, up to a maximum of $50 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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