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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 2026, 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 2026.
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 $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:
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Drug Coverage
The Provider Partners Maryland Essential Plan (HMO I-SNP) has an annual prescription drug deductible of $615. You will need to pay this amount out of pocket for your covered medications before the plan begins to pay its share of your prescription costs. Specific drug coverage tier details, such as copays and coinsurance rates for different formulary tiers, are currently unavailable for this plan. To determine your exact coverage and out-of-pocket costs for specific medications, you should consult the plan's formulary list or contact the provider directly.
Additional Benefits
The Provider Partners Maryland Essential Plan (HMO I-SNP) offers comprehensive medical coverage with no copays for primary care, specialist visits, preventive care, and outpatient services, though a 20% coinsurance typically applies. Inpatient hospital stays and skilled nursing facility care are covered with no coinsurance, but they do require Medicare-defined copays and prior authorization. Emergency and urgent care services are also available with no copay and a 20% coinsurance, which is waived if you are admitted. For supplemental care, the plan features dental benefits up to a $3,000 annual limit and hearing aid coverage up to $2,000 every two years with no copays or coinsurance. Members also benefit from routine vision care with no copay and a 20% coinsurance up to a $300 annual limit. Additional perks include up to 40 one-way transportation trips per year to health-related locations and a $150 quarterly over-the-counter allowance, both offered with no copay and no coinsurance.
Inpatient Hospital See details
Provider Partners Maryland Essential Plan (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization and Medicare-defined copays apply. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for ambulatory surgical center, outpatient hospital, and outpatient substance abuse services.
Partial Hospitalization See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), which features a 20% coinsurance and no copay for both ground and air ambulance services. Additionally, the plan covers up to 40 one-way trips per year to any health-related location with no copay and no coinsurance.
Emergency Services See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers emergency services with a 20% coinsurance (up to $100 per visit, waived if admitted within 24 hours) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit, waived if admitted within 3 days) and no copay. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, though some therapy services require prior authorization. Chiropractic services are not covered in practice because routine and other chiropractic services are excluded, while routine podiatry is covered for up to four visits per year.
Preventive Services See details
Preventive services are covered under the Provider Partners Maryland Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance for annual exams, kidney disease education, and screenings. However, additional benefits like fitness programs, health education, and in-home safety assessments are not covered.
Hearing Services See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers hearing services with no deductible, offering routine exams and prescription hearing aids with no copay, though routine exams require a 20% coinsurance. Prescription hearing aids (inner, outer, and over-the-ear) are covered with no coinsurance up to a $2,000 limit every two years, while over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are partially covered under the Provider Partners Maryland Essential Plan (HMO I-SNP), featuring no copays and a 20% coinsurance for routine eye exams and eyewear, with a $300 annual limit and no deductibles. Other eye exam services, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), featuring Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental services are covered up to a $3,000 annual maximum with no copay and no coinsurance, with the exception of adjunctive general services which are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Provider Partners Maryland Essential Plan (HMO I-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Maryland Essential Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiological services, with no copay and a 20% coinsurance. Prior authorization is required for diagnostic procedures, tests, and lab services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Maryland Essential Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Provider Partners Maryland Essential Plan (HMO I-SNP) covers Cardiac Rehabilitation Services with no copay, though prior authorization is required. Only some services are covered, as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by the Provider Partners Maryland Essential Plan (HMO I-SNP) with no coinsurance, requiring prior authorization and Medicare-defined copays. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Provider Partners Maryland Essential Plan (HMO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $150 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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