A non-government entity
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 2025, 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 3.5 out of 5 stars in 2025.
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 $51.00. 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 $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:
Sign up for Provider Partners Missouri Advantage Plan (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Provider Partners Missouri Advantage Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2,000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $51. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Missouri Advantage Plan (HMO I-SNP) offers a range of benefits, including coverage for outpatient services, emergency services, and primary care, all with a 20% coinsurance. The plan also covers home health services with no copay or coinsurance. This plan offers additional benefits such as hearing aids with a maximum benefit of $2000 every two years, and dental services up to $3,500 per year. Additionally, the plan covers over-the-counter (OTC) items with a maximum benefit of $120.00 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the specific cost-sharing details for each are not provided. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP) with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay, but with a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are covered for up to 38 one-way trips per year. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Provider Partners Missouri Advantage Plan (HMO I-SNP) covers Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Additional Telehealth Benefits and Opioid Treatment Program Services with 20% coinsurance. Occupational Therapy and Physical Therapy/Speech-Language Pathology Services are covered with no coinsurance or copay, but require prior authorization. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, an annual physical exam with 20% coinsurance, and kidney disease education services with 20% coinsurance. Additional services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered. Other preventive services like Glaucoma Screening, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20%, while routine hearing exams are limited to one per year. Prescription hearing aids are covered, with a maximum benefit of $2000 every two years, and inner, outer, and over-the-ear aids are covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with 20% coinsurance, routine eye exams with no coinsurance, and eyewear with 20% coinsurance, up to a combined maximum of $300 per year. Eyeglass lenses and frames, and contact lenses are covered, but eyeglass frames and upgrades are not covered.
Dental Services See details
The Provider Partners Missouri Advantage Plan (HMO I-SNP) covers dental services, including Medicare Dental Services with 20% coinsurance. Other dental services are covered with a maximum plan benefit of $3,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Provider Partners Missouri Advantage Plan (HMO I-SNP). There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. 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 and radiological services, are covered. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while there is no copay.
Home Health Services See details
Home Health Services are covered by the Provider Partners Missouri Advantage Plan (HMO I-SNP), with no copay or coinsurance. 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 Missouri Advantage 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 additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The Provider Partners Missouri Advantage Plan (HMO I-SNP) does not cover acupuncture, meal benefits, or dual eligible SNPs with highly integrated services. The plan covers over-the-counter (OTC) items, with a maximum benefit of $120.00 every three months. This plan also does not cover early and periodic screening, diagnostic, and treatment services, private duty nursing services, case management, 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, and self-directed personal assistance services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved