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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 2026, 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 2026.
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 $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 Indiana Community Plan (HMO I-SNP) has an annual prescription drug deductible of $615. You will need to pay this deductible amount out of pocket for your covered medications before the plan begins to cover its portion of your prescription costs. Specific drug coverage tier details, including copayments and coinsurance rates, are not available for this plan. To fully understand your potential out-of-pocket expenses, you should consult the plan's specific drug formulary to see how your individual medications are classified.
Additional Benefits
The Provider Partners Indiana Community Plan (HMO I-SNP) offers comprehensive medical coverage where many outpatient, diagnostic, emergency, and specialist services require no copay and a 20% coinsurance. Primary care, occupational, physical, and speech therapies are highly affordable with a $10 copay and no coinsurance. Essential recovery services like home health care and skilled nursing facility stays are fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits to help manage everyday health costs. Members receive routine dental care up to $3,000 annually and prescription hearing aids up to $2,000 every two years with no copay or coinsurance. Furthermore, the plan provides up to 46 one-way health-related transportation trips per year and a $100 quarterly over-the-counter item allowance with no copay and no coinsurance.
Inpatient Hospital See details
Provider Partners Indiana Community Plan (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though Medicare-defined copayments and prior authorization are required. Additional hospital days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Provider Partners Indiana Community Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. The plan also offers transportation services to any health-related location with no copay and no coinsurance, limited to 46 one-way trips per year.
Emergency Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers emergency services 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 are also covered with a 20% coinsurance (up to $45 per visit) and no copay, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers primary care, occupational therapy, and physical or speech therapy with a $10 copay and no coinsurance, while specialist, mental health, podiatry, psychiatric, telehealth, and opioid treatment services require no copay and 20% coinsurance. Chiropractic services are not covered in practice because routine and other chiropractic sub-services are excluded.
Preventive Services See details
Preventive services are partially covered by the Provider Partners Indiana Community Plan (HMO I-SNP), offering annual physical exams, kidney disease education, and select screenings with no copay and a 20% coinsurance. Additional preventive services, including health education, fitness benefits, weight management, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are partially covered by Provider Partners Indiana Community Plan (HMO I-SNP), offering routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered with no copay or coinsurance up to a $2,000 limit every two years, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Provider Partners Indiana Community Plan (HMO I-SNP), offering covered services with no copay and a 20% coinsurance for routine eye exams and contact lenses. While routine exams (one per year), contact lenses, eyeglass lenses, and frames are covered up to a $300 annual limit, other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the Provider Partners Indiana Community Plan (HMO I-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental benefits feature no copay and no coinsurance up to a $3,000 annual maximum, though adjunctive general services are not covered.
Home Infusion bundled Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Indiana Community Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Provider Partners Indiana Community Plan (HMO I-SNP) with a 20% coinsurance and no copay. This comprehensive coverage includes diagnostic procedures, lab services, outpatient X-rays, and therapeutic radiological services, with prior authorization required for diagnostic services.
Home Health Services See details
Home Health Services are covered by Provider Partners Indiana Community Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) does not cover Cardiac Rehabilitation Services in practice, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered. While there is no copay, these rehabilitation services require a 20% coinsurance and prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Provider Partners Indiana Community Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. The plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond standard Medicare-covered days are not covered.
Other Services See details
Provider Partners Indiana Community Plan (HMO I-SNP) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $100 maximum limit every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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