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Provider Partners Kentucky Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Kentucky 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 Kentucky Advantage Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Kentucky Advantage Plan (HMO I-SNP) is a HMO I-SNP plan offered by Rifkin Managed Care Holding, LLC available for enrollment in 2026 to people living in Some Kentucky Counties. The overall rating for this plan is not yet available for 2026.
It's important to know that Provider Partners Kentucky 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 Kentucky 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 Kentucky 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 Kentucky 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 Kentucky Advantage Plan (HMO I-SNP) features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before your insurance coverage kicks in. Understanding this initial cost is a key factor when evaluating your total yearly healthcare budget. Specific details regarding drug coverage tiers, copays, and coinsurance are not available for this plan. To determine the exact costs for your specific prescriptions, you should contact the plan provider directly to review their formulary. This will help you verify if your medications are covered and what your ongoing costs will be.
Additional Benefits
The Provider Partners Kentucky Advantage Plan (HMO I-SNP) offers comprehensive healthcare coverage with no copays for the majority of its medical services, typically utilizing a 20% coinsurance instead. Inpatient hospital stays are covered with no coinsurance, though Medicare-defined copays and deductibles do apply. Most outpatient services, primary and specialist care, emergency visits, and diagnostic tests are covered with no copay and a 20% coinsurance. This plan also provides robust supplemental benefits, including home health care and skilled nursing facility stays with no copay and no coinsurance. Members can take advantage of no copays and no coinsurance for routine transportation, dental care up to $3,000 annually, select hearing aids up to $2,000 every two years, and a $125 quarterly over-the-counter allowance. Vision services, including routine exams and up to $300 annually for eyewear, are also available with no copay and a 20% coinsurance.
Inpatient Hospital See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, though Medicare-defined copays and deductibles apply and prior authorization is required. Additional hospital days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers outpatient services with no copay and a 20% coinsurance, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Routine transportation is also covered with no copay and no coinsurance for up to 72 one-way trips per year to any health-related location, though plan-approved health-related locations are not covered.
Emergency Services See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, both of which count toward the plan deductible. Coinsurance is waived if you are admitted to the hospital within 24 hours for emergency care or 3 days for urgent care, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers primary care, specialist, psychiatric, and mental health services with no copay and a 20% coinsurance, while physical, occupational, and speech therapies are covered with no copay and no coinsurance. Routine chiropractic services are not covered, but telehealth, opioid treatment, and up to 12 routine podiatry visits per year are covered with no copay and a 20% coinsurance.
Preventive Services See details
Preventive services under the Provider Partners Kentucky Advantage Plan (HMO I-SNP) are covered with no copay and a 20% coinsurance for annual physical exams, kidney disease education, and select screenings. Additional preventive benefits, including fitness programs, health education, and weight management services, are not covered.
Hearing Services See details
Hearing services are partially covered under the Provider Partners Kentucky Advantage Plan (HMO I-SNP), as OTC hearing aids and general prescription hearing aids (all types) are not covered. Covered routine hearing exams have no copay and a 20% coinsurance (limited to one per year), while fitting evaluations and select prescription hearing aids (inner, outer, and over-the-ear) are covered with no copay and no coinsurance up to a $2,000 maximum limit every two years.
Vision Services See details
Vision Services are covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP) with no copay, no deductible, and a 20% coinsurance for routine exams and contact lenses. This benefit provides one routine eye exam annually and up to $300 per year for eyewear like contact lenses, eyeglass lenses, and frames, though upgrades, other eye exams, and complete eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP), with adjunctive general services not covered. Medicare-covered dental services have no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services require no copay and no coinsurance up to a $3,000 annual maximum.
Home Infusion bundled Services See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation drugs, require no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Kentucky Advantage 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 and prosthetics or medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Provider Partners Kentucky Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance. This coverage includes diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays, with prior authorization required for diagnostic services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP) because cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are all not covered. If received, these services require a 20% coinsurance and no copay, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
Provider Partners Kentucky Advantage Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Provider Partners Kentucky Advantage Plan (HMO I-SNP), which provides a $125 quarterly allowance for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other supplemental services are not covered under this plan.
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