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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 2026, 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 2026.
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 $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 Essential Plan (HMO I-SNP) requires an annual prescription drug deductible of $615. You must pay this deductible amount out-of-pocket for your covered medications before the plan starts helping to cover your prescription costs. Detailed information regarding specific drug tiers, copays, and coinsurance is currently unavailable for this plan. To find out how your specific medications are covered, we recommend reviewing the plan's formulary list or contacting the plan provider directly.
Additional Benefits
The Provider Partners Indiana Essential Plan (HMO I-SNP) offers robust medical coverage featuring no copays for most outpatient, emergency, primary care, and diagnostic services, though a standard 20% coinsurance typically applies. While inpatient hospital stays require Medicare-defined copayments, home health care and skilled nursing facility services are fully covered with no copays or coinsurance. Prior authorization is required for several major services, including inpatient stays, therapy, and durable medical equipment. Members also benefit from supplemental coverage for dental, vision, hearing, and transportation services with no copays. Preventive dental care and prescription hearing aids are covered with no coinsurance up to specific plan limits, while routine vision and hearing exams carry a 20% coinsurance. Additionally, the plan includes up to 30 free one-way transportation trips per year and a $125 quarterly allowance for over-the-counter items with no copays or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Provider Partners Indiana Essential Plan (HMO I-SNP) with no coinsurance, though Medicare-defined copayments apply and prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Indiana Essential Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. There is no deductible for outpatient blood services, and the first three pints of blood are waived, though prior authorization is required for several of these services.
Partial Hospitalization See details
The Provider Partners Indiana Essential Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Provider Partners Indiana Essential Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 30 one-way trips per year to any health-related location with no copay and no coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with a 20% coinsurance and no copay, up to a maximum of $100 per visit which is waived if admitted to the hospital within 24 hours. Urgently needed services also have a 20% coinsurance and no copay, up to a $40 maximum per visit, while worldwide emergency, urgent, and emergency transportation services are not covered.
Primary Care See details
Primary care services under the Provider Partners Indiana Essential Plan (HMO I-SNP) are covered with no copay and either a 20% coinsurance or no coinsurance, depending on the service. Most benefits, including primary care, specialist, mental health, psychiatric, podiatry, and telehealth services, carry a 20% coinsurance, while occupational, physical, and speech therapies have no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and 20% coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. While some additional preventive services are covered, sub-services like fitness benefits, health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Provider Partners Indiana Essential Plan (HMO I-SNP) covers hearing exams with no deductible, no copay, and a 20% coinsurance for routine exams, as well as prescription hearing aids with no copay and no coinsurance. Up to $2,000 is covered every two years for inner, outer, and over-the-ear prescription hearing aids, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Provider Partners Indiana Essential Plan (HMO I-SNP), offering routine eye exams and select eyewear with no copay, though a 20% coinsurance applies to routine exams and contact lenses. Covered eyewear, including lenses, frames, and contacts, is subject to a $150 annual maximum, while other eye exams, upgrades, and packaged eyeglasses are not covered.
Dental Services See details
Provider Partners Indiana Essential Plan (HMO I-SNP) offers partially covered dental services, with Medicare-covered dental requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental services have 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 Essential Plan (HMO I-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Indiana Essential Plan (HMO I-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance for lab services, diagnostic procedures, X-rays, and therapeutic radiological services. Prior authorization is required for outpatient diagnostic procedures and laboratory services.
Home Health Services See details
Home health services are covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and require prior authorization. However, some services are covered but require a 20% coinsurance, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by the Provider Partners Indiana Essential Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. The plan permits SNF admission without a prior three-day inpatient hospital stay, but additional days beyond standard Medicare coverage are not covered.
Other Services See details
Other services are partially covered by the Provider Partners Indiana Essential Plan (HMO I-SNP), which provides over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $125 every three months. Acupuncture and meal benefits are not covered under this plan.
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