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Provider Partners Missouri Community Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Missouri 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 Missouri Community Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Provider Partners Missouri 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 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 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 Missouri 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 Missouri 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 Missouri 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 Missouri Community Plan (HMO I-SNP) has an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your plan coverage begins. Detailed information regarding specific drug tiers, copayments, and coinsurance is not currently available for this plan. For precise cost estimates on your specific prescriptions, you should consult the plan's comprehensive formulary.
Additional Benefits
The Provider Partners Missouri Community Plan (HMO I-SNP) offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and a 20% coinsurance for most outpatient, emergency, diagnostic, and specialist services. Primary care visits require a $10 copay with no coinsurance, while inpatient hospital stays are subject to Medicare-defined copays and no coinsurance. Home health services are fully covered with no copay and no coinsurance, ensuring affordable care at home. For supplemental care, this plan provides robust dental benefits with no copay and no coinsurance up to a $3,000 annual limit, alongside routine hearing and vision services. Members benefit from a $2,000 hearing aid allowance every two years with no copay and a $300 annual limit for vision hardware with a 20% coinsurance. Additionally, the plan includes up to 28 free one-way transportation trips per year and a $100 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Provider Partners Missouri Community Plan (HMO I-SNP) partially covers inpatient hospital services, which require prior authorization and subject you to Medicare-defined copays with no coinsurance. Additional acute or psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by the Provider Partners Missouri Community 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 Community 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 or coinsurance for up to 28 one-way trips per year to any health-related location, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services are covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with a 20% coinsurance and no copay, up to a maximum of $100 per visit, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services also feature no copay and a 20% coinsurance up to $45, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers primary care, occupational therapy, and physical or speech therapy with a $10 copay and no coinsurance, though chiropractic services are not covered. Specialist visits, mental health, psychiatric, podiatry, and telehealth services are covered with no copay and a coinsurance of 20% (or up to 20% for other health professionals).
Preventive Services See details
Preventive services are covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with no copay, though a 20% coinsurance applies to the annual physical exam, kidney disease education, and screenings like glaucoma and diabetes self-management. The benefit is partially covered, as many additional services, including fitness programs, health education, and in-home safety assessments, are not covered.
Hearing Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers hearing services, including routine exams with no copay and 20% coinsurance, and fitting evaluations. 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
Vision services are partially covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with no deductibles, no copays, and a 20% coinsurance for routine eye exams and contact lenses. This benefit includes one routine eye exam per year and a $300 annual limit for contact lenses, eyeglass lenses, and eyeglass frames, though other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) provides partially covered dental services with a $3,000 annual maximum, offering most preventive and comprehensive services with no copay and no coinsurance, though adjunctive general services are not covered. Medicare-covered dental services are also covered with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, but there are no preferred vendor or manufacturer restrictions.
Diagnostic and Radiological Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all diagnostic procedures, tests, and lab services.
Home Health Services See details
Home Health Services are covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Provider Partners Missouri Community Plan (HMO I-SNP), as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all not covered. For these services, prior authorization is required, and members are responsible for a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Provider Partners Missouri Community Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and Medicare-defined copays, requiring prior authorization but no three-day prior hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Provider Partners Missouri Community Plan (HMO I-SNP) partially covers Other Services, which includes Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $100 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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