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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 2026, 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 2026.
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 $31.20. 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:
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) features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug tier copayments and coinsurance details are not currently available for this plan. To understand your exact medication costs, it is recommended to review the plan's formulary directly to see how your specific prescriptions are covered after meeting the deductible.
Additional Benefits
The Provider Partners Maryland Advantage Plan (HMO I-SNP) offers robust coverage for core medical services, generally featuring no copay and a 20% coinsurance for outpatient care, doctor visits, and emergency services. Inpatient hospital stays are covered with no coinsurance subject to Medicare-defined cost-sharing, while skilled nursing facility stays, home health services, and physical therapy require no copay and no coinsurance. Durable medical equipment, diagnostic tests, and dialysis are also covered with no copay and a 20% coinsurance. For supplemental benefits, the plan features comprehensive dental coverage with no copay and no coinsurance up to a $5,000 annual maximum, alongside annual routine vision exams with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $2,000 limit every two years, and members receive a $175 over-the-counter credit every three months with no copay and no coinsurance. Additionally, the plan covers up to 54 one-way trips per year to health-related locations with no copay and no coinsurance.
Inpatient Hospital See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though Medicare-defined cost-sharing applies and prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Maryland Advantage 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. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services.
Partial Hospitalization See details
Provider Partners Maryland Advantage 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
Ambulance and transportation services are covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP), with Medicare-covered ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 54 one-way trips per year to any health-related location, though transport to plan-approved health-related locations is not covered.
Emergency Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) emergency and urgently needed services are covered with a 20% coinsurance (up to $100 and $40 per visit, respectively) and no copay, with costs counting toward the plan-level 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 Maryland Advantage Plan (HMO I-SNP) covers primary care, specialist, telehealth, and mental health services with no copay and a 20% coinsurance, though chiropractic services are not covered. Physical, occupational, and speech-language therapy services are also covered with no copay and no coinsurance, subject to prior authorization.
Preventive Services See details
Preventive Services are partially covered under the Provider Partners Maryland Advantage Plan (HMO I-SNP), with covered services like annual physicals, kidney disease education, and glaucoma screenings requiring no copay and a 20% coinsurance. However, additional services such as fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, bathroom safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP), as OTC hearing aids and general prescription hearing aid types are not covered. Covered services include routine exams with no copay and a 20% coinsurance, alongside inner, outer, and over-the-ear prescription hearing aids with no copay, no coinsurance, and a $2,000 maximum limit every two years.
Vision Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year with no copay and no coinsurance. Covered eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, features no copay and a 20% coinsurance for contact lenses up to a $300 annual limit, though other eye exam services, complete eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) dental services are partially covered, offering Medicare-covered dental services with no copay and 20% coinsurance. Other preventive and comprehensive dental services have no copay and no coinsurance up to a $5,000 annual maximum, although adjunctive general services are not covered.
Home Infusion bundled Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) covers 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
Provider Partners Maryland Advantage Plan (HMO I-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. These covered services include lab work, diagnostic procedures, 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 the Provider Partners Maryland 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 covered under the Provider Partners Maryland Advantage Plan (HMO I-SNP) with no copay and require prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Provider Partners Maryland Advantage Plan (HMO I-SNP) with no copay and no coinsurance, subject to prior authorization. The plan allows for SNF admission without a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Provider Partners Maryland Advantage Plan (HMO I-SNP) partially covers other services, offering an over-the-counter (OTC) benefit of up to $175 every three months with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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