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Provider Partners Maryland Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Maryland 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 Maryland Advantage Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Maryland Advantage 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 Western & Central Maryland. The overall rating for this plan is not yet available for 2025.
It's important to know that Provider Partners Maryland 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 Maryland 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 Maryland 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 Maryland Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.30. 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:
Sign up for Provider Partners Maryland Advantage Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners Maryland Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs associated with your drugs based on the tier and the pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase. During this phase, you pay nothing for your Part D covered drugs.
Additional Benefits
The Provider Partners Maryland Advantage Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services, such as home health, are covered with no copay or coinsurance. Other services, like outpatient services and diagnostic procedures, have a 20% coinsurance. This plan also includes coverage for dental, vision, and hearing services. Dental services include coverage for Medicare Dental Services and other dental services with an annual maximum. Vision services cover eye exams and eyewear with coinsurance, and hearing services cover routine hearing exams and hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay, with details on the copay available in the plan's documentation. Additional days, non-Medicare covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered with a 20% coinsurance. Outpatient Blood Services has an enhanced benefit, waiving the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP), with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP). Ground and air ambulance services have no copay, but a 20% coinsurance. Transportation services to any health-related location are covered for up to 42 one-way trips per year, with no copay or coinsurance. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP) with a 20% coinsurance, and no copay. However, Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Provider Partners Maryland Advantage Plan (HMO I-SNP) covers primary care physician services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, but routine chiropractic care is not covered. Occupational therapy and physical therapy/speech-language pathology services are covered with no coinsurance or copay, but prior authorization is required.
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, glaucoma screening, barium enemas, digital rectal exams, and EKG following a Welcome Visit with a 20% coinsurance. Additional preventive services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a coinsurance of at most 20% and one visit per year, and fitting/evaluation for hearing aids with 4 visits every two years. Prescription Hearing Aids are partially covered, with Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear benefits covered, and Prescription Hearing Aids (all types) not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams have a 20% coinsurance, and routine eye exams have no coinsurance. Eyewear has a 20% coinsurance, and contact lenses are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services under the Provider Partners Maryland Advantage Plan (HMO I-SNP) include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $5,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, with a limit of two visits per year. Restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are also covered. Adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance with no copay, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP), with no copay or coinsurance. 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 Maryland Advantage Plan (HMO I-SNP). While the plan covers some cardiac rehabilitation services, the specific services listed are not covered.
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.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, while 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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