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Provider Partners Maryland Community Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Maryland Community 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 Community Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Maryland Community 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 Community 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 Community 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 Community 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 Community Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $3750.00 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 Maryland Community 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 the plan begins to pay its share. Understanding this upfront cost is an important step when evaluating if this Medicare plan fits your budget and healthcare needs. Specific details regarding copayments, coinsurance, and drug coverage tiers are currently unavailable for this plan. To fully estimate your out-of-pocket costs for specific prescriptions, we recommend contacting the plan provider directly to review their complete formulary. This will help ensure you have all the necessary pricing details before making an enrollment decision.
Additional Benefits
The Provider Partners Maryland Community Plan (HMO I-SNP) provides robust medical coverage where most outpatient, specialist, and emergency services require a 20% coinsurance and no copay. Primary care visits are available with a $10 copay and no coinsurance, while home health services and skilled nursing care feature no copay and no coinsurance. Inpatient hospital stays are covered with no coinsurance, though Medicare-defined copays do apply. For extra wellness needs, the plan offers dental benefits up to a $3,000 yearly maximum and hearing aids up to $2,000 every two years with no copay and no coinsurance. Vision exams and routine hearing tests carry a 20% coinsurance and no copay, and members receive a $300 annual eyewear allowance with no copay. To support daily health, the plan also includes up to 30 one-way trips to medical appointments with no copay or coinsurance, alongside a $100 over-the-counter quarterly allowance.
Inpatient Hospital See details
Provider Partners Maryland Community Plan (HMO I-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required and Medicare-defined copays apply. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Provider Partners Maryland Community Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Provider Partners Maryland Community Plan (HMO I-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered with no copay or coinsurance, offering up to 30 one-way trips per year to any health-related location, while plan-approved health-related location services are not covered.
Emergency Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered. The emergency coinsurance is waived if you are admitted to the hospital within 24 hours (up to a $100 maximum per visit), and the urgently needed services coinsurance is waived if you are admitted within 3 days (up to a $45 maximum per visit).
Primary Care See details
Primary care services under the Provider Partners Maryland Community Plan (HMO I-SNP) are covered with a $10 copay and no coinsurance for primary care doctor visits, occupational therapy, and physical therapy, while chiropractic services are not covered. Specialist visits, mental health, psychiatric services, and telehealth are also covered, requiring no copay and a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by the Provider Partners Maryland Community Plan (HMO I-SNP), offering annual physicals, kidney disease education, and glaucoma screenings with no copay and a 20% coinsurance. While some additional preventive services are covered, key benefits like fitness programs, health education, and in-home support are not covered.
Hearing Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) covers routine hearing exams with no copay and a 20% coinsurance, plus up to four fitting evaluations every two years. Prescription hearing aids are covered with no copay and no coinsurance up to a $2,000 limit every two years, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) offers partially covered vision services with no deductibles or copays, though a 20% coinsurance applies to routine eye exams and contact lenses. Covered eyewear is limited to a $300 annual maximum, but other eye exam services, upgrades, and complete eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under the Provider Partners Maryland Community Plan (HMO I-SNP), with adjunctive general services not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other preventive and comprehensive dental services feature no copay and no coinsurance up to a $3,000 yearly maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Provider Partners Maryland Community Plan (HMO I-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs incur no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Maryland Community Plan (HMO I-SNP) with no copay and a 20% coinsurance. This coverage helps you manage the costs of your essential kidney dialysis treatments.
Medical Equipment See details
Provider Partners Maryland Community 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, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) covers diagnostic and radiological services with no copayment and a 20% coinsurance for all lab services, diagnostic procedures, X-rays, and therapeutic radiological services. Prior authorization is required for all diagnostic procedures, tests, and lab services.
Home Health Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by the Provider Partners Maryland Community Plan (HMO I-SNP) with no copay and prior authorization, although some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Provider Partners Maryland Community Plan (HMO I-SNP) with no coinsurance and no copay for tier 1 days, though prior authorization is required. While standard Medicare-covered days are included without requiring a prior three-day hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Provider Partners Maryland Community Plan (HMO I-SNP) partially covers other services, featuring a $100 allowance every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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