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Provider Partners Indiana Essential Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Indiana Essential 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 Essential Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Indiana Essential 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 Essential 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 Essential 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 Essential 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 Essential 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 Essential Plan (HMO I-SNP) has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help". If you qualify for LIS, your monthly premium will be $49.60.
Additional Benefits
The Provider Partners Indiana Essential Plan (HMO I-SNP) offers a range of benefits, including coverage for inpatient and outpatient services, with coinsurance typically around 20%. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, each with specific coinsurance or maximum benefit limits. Additional benefits include ambulance services, home health, medical equipment, and diagnostic services. The plan also offers coverage for home infusion services and dialysis services. However, certain services like cardiac rehabilitation, additional home health care hours, and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days for inpatient hospital, non-Medicare-covered stays, and upgrades for acute care are not covered. The copay for inpatient hospital services is not specified in this snippet.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance, and outpatient substance abuse services have a minimum coinsurance of 20% and a maximum 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 and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to any health-related location. Transportation services to a plan-approved health-related location are not covered, but the plan covers 14 one-way trips per year to any health-related location using rideshares, bus/subway, medical transport, or other modes of transportation.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered by the plan. Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while the plan does not cover routine chiropractic care. Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a coinsurance that varies between 0% and 20%.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, an annual physical exam with 20% coinsurance, and kidney disease education services with 20% coinsurance. Some additional preventive services, such as health education and in-home safety assessments, are not covered. Other preventive services such as glaucoma screenings, and digital rectal exams have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with at most 20% coinsurance, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (4 every two years). Prescription hearing aids are partially covered, with coverage for inner ear, outer ear, and over-the-ear hearing aids, but not all types of hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with 20% coinsurance, and eyewear with 20% coinsurance and a combined maximum benefit of $150.00 per year. Eyeglass lenses, eyeglass frames, and contact lenses are covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Provider Partners Indiana Essential Plan (HMO I-SNP) covers dental services, with a 20% coinsurance for Medicare dental services. Other dental services have a maximum benefit of $3,000 per year, and specific services like oral exams, dental x-rays, and cleanings are limited to one visit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP). The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are also covered, each with 20% coinsurance. 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. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay or coinsurance. However, 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 Essential 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 coverage and non-Medicare-covered stays are not covered. Prior authorization is required for SNF services.
Other Services See details
Other services offered by the Provider Partners Indiana Essential Plan (HMO I-SNP) include Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, but does not cover 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.
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