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Provider Partners Maryland Essential Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Maryland 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 Maryland Essential Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Maryland 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 Western and Central Maryland. The overall rating for this plan is not yet available for 2025.
It's important to know that Provider Partners Maryland 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 Maryland 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 Maryland 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 Maryland Essential Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.10. 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:
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Drug Coverage
The Provider Partners Maryland Essential Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay the costs for drugs in each tier. The plan's formulary provides more details on specific drug costs. If you qualify for the low-income subsidy (LIS), your monthly premium will be $19.10. Once your total drug costs reach $2,000, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Maryland Essential Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services have a 20% coinsurance, including outpatient services, emergency services, primary care, vision, and dental. Some services, such as home health and diagnostic services, have no copay or coinsurance. The plan also provides coverage for hearing exams and hearing aids with a maximum benefit, and covers transportation services. Additional benefits include a $50 quarterly allowance for over-the-counter items. However, certain services like cardiac rehabilitation and some preventive services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the plan does not specify the cost sharing details. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance. Ambulatory surgical center, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, with no copay. Transportation Services to any health-related location are covered for 14 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP) with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Provider Partners Maryland Essential Plan (HMO I-SNP) covers Primary Care services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, but routine care is not covered.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams with 20% coinsurance, and kidney disease education services. Some additional preventive services like health education, in-home safety assessments, and others are not covered. Other preventive services, such as glaucoma screening, digital rectal exams, and EKGs, have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, and routine hearing exams with 1 visit every year. The plan also covers fitting/evaluation for hearing aids with 4 visits every two years, as well as prescription hearing aids including inner ear, outer ear, and over-the-ear hearing aids. Prescription hearing aids have a maximum plan benefit of $1,000 every two years, but prescription hearing aids (all types) and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a 20% coinsurance for both. Routine eye exams are covered once per year, and contact lenses, eyeglass lenses, and eyeglass frames are covered with no limits. Eyewear has a combined maximum plan benefit coverage of $150 per year.
Dental Services See details
Dental Services are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum plan benefit of $3000 every year, and include Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics. Adjunctive General Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%. Other Medicare Part B drugs, including chemotherapy and radiation drugs, have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and requires authorization. Prosthetic devices and medical supplies have a 20% coinsurance. Diabetic supplies and therapeutic shoes/inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered with no copay and a coinsurance of at most 20%. Therapeutic radiological services, diagnostic radiological services, and outpatient X-ray services are also covered with no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), with no copay or coinsurance, but prior authorization is required. 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 Essential Plan (HMO I-SNP). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered, nor does it cover non-Medicare-covered stays. Prior authorization is required, and the copay information is available below.
Other Services See details
The Provider Partners Maryland Essential Plan (HMO I-SNP) does not cover 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, or Self-Directed Personal Assistance Services. The plan does offer over-the-counter (OTC) items with a maximum benefit coverage of $50.00 every three months.
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