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Provider Partners Missouri Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Missouri 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 Missouri Advantage Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Missouri 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 Select Missouri Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Provider Partners Missouri 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 Missouri 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 Missouri 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 Missouri Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. 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 $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 Missouri Advantage Plan (HMO I-SNP) has an annual prescription drug deductible of $615. Under this plan, you will need to pay this deductible amount out-of-pocket for your medications before your prescription coverage kicks in. Specific drug tier details, including copayments and coinsurance percentages for individual drugs, are not available for this plan. When evaluating your Medicare options, factoring in this $615 drug deductible is essential for estimating your total annual healthcare costs. To find out if your specific prescriptions are covered and what they will cost, it is recommended to contact the plan directly for a complete formulary.
Additional Benefits
The Provider Partners Missouri Advantage Plan (HMO I-SNP) offers comprehensive medical coverage with no copays for most services, though many require a 20% coinsurance. Inpatient hospital stays, home health services, and skilled nursing facility care are covered with no copay and no coinsurance. Outpatient care, specialist visits, emergency services, and durable medical equipment generally feature no copay and a 20% coinsurance. This plan also includes valuable supplemental benefits like routine dental care up to $5,000 annually and hearing aids up to $2,000 every two years with no copays or coinsurance. Additionally, members receive up to 42 free one-way transportation trips per year and a $152 quarterly allowance for over-the-counter items. Routine eye exams are covered with no copay, while eyewear is subject to a 20% coinsurance up to $300 annually.
Inpatient Hospital See details
Inpatient hospital services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay and no coinsurance, though Medicare-defined cost sharing and prior authorization are required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Missouri Advantage 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 outpatient hospital, surgical, and substance abuse services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance, offering up to 42 one-way trips per year to any health-related location, though transport to plan-approved locations is not covered.
Emergency Services See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers emergency services with a 20% coinsurance (maximum $100 per visit) and no copay, and urgently needed services with a 20% coinsurance (maximum $40 per visit) and no copay. Both cost shares count toward the plan deductible, and coinsurance is waived if you are hospitalized within 24 hours for emergency care or 3 days for urgent care. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers primary care, specialist, psychiatric, mental health, telehealth, and podiatry services with no copay and a 20% coinsurance. Physical, speech, and occupational therapies are covered with no copay and no coinsurance, while chiropractic services are partially covered as routine and other chiropractic care are not covered.
Preventive Services See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) partially covers preventive services with no copay and a 20% coinsurance for annual physical exams, kidney disease education, and select screenings. However, additional preventive benefits—including fitness programs, health education, and personal emergency response systems—are not covered.
Hearing Services See details
Hearing services are partially covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP), featuring routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations. Prescription hearing aids are covered with no copay and no coinsurance up to a $2,000 maximum every two years, but over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers vision services with no deductibles and no copays, including one routine eye exam per year with no coinsurance. Covered eyewear, such as contact lenses, eyeglass lenses, and eyeglass frames, is subject to a 20% coinsurance up to a $300 yearly limit, though upgrades, other eye exams, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP), which offers Medicare-covered dental with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $5,000 annual limit. Most preventive and comprehensive dental services are covered under this plan, though adjunctive general services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers medical equipment, including 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
Diagnostic and radiological services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay and a 20% coinsurance for all diagnostic tests, lab services, radiological services, and outpatient x-rays. Prior authorization is required for diagnostic services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP) with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Provider Partners Missouri Advantage Plan (HMO I-SNP), as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Provider Partners Missouri Advantage Plan (HMO I-SNP) partially covers other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a limit of $152 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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