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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 2025, 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 3.5 out of 5 stars in 2025.
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 $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 $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 a $590 deductible for prescription drugs. After the deductible, you will pay costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D costs will be $0. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Missouri Community Plan (HMO I-SNP) offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. Many services, such as primary care, home health, and diagnostic services, come with no copay. Other benefits include dental and vision coverage, with specific allowances for dental services and eyewear. This plan provides coverage for emergency services, hearing exams, and transportation to health-related locations. You will have a coinsurance for certain services such as outpatient services, and you should note that some services require prior authorization. The plan also offers coverage for medical equipment, home infusion, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay that is defined by Medicare. 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 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, while outpatient blood services also have a 20% coinsurance. Ambulatory surgical center services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Provider Partners Missouri Community 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 by the Provider Partners Missouri Community Plan (HMO I-SNP). 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, using rideshare services, bus/subway, medical transport, and other modes of transportation, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency Services are covered under the Provider Partners Missouri Community Plan (HMO I-SNP), including a 20% coinsurance, no copay, and a maximum per visit amount of $100. Urgently Needed Services are also covered with a 20% coinsurance, no copay, and a maximum per visit amount of $45. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services are covered with no copay and no coinsurance. 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 are covered with a 20% coinsurance. However, Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and annual physical exams with 20% coinsurance. Additional preventive services are not covered, including health education, in-home safety assessments, and more. Other preventive services such as Glaucoma Screening, Barium Enemas, and Digital Rectal Exams have a coinsurance between 20% and 20%.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20%, with no deductible. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered up to four times every two years. Prescription hearing aids are partially covered, with a maximum benefit of $2000 every two years, and inner, outer, and over-the-ear hearing aids are covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and a routine eye exam once per year. Eyewear includes a $300 combined maximum plan benefit per year with 20% coinsurance for contact lenses, while eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Provider Partners Missouri Community Plan (HMO I-SNP) covers dental services, including Medicare dental services with 20% coinsurance. Other dental services are covered up to a maximum of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0-20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Provider Partners Missouri Community Plan (HMO I-SNP) with a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
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, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners Missouri Community Plan (HMO I-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and there is a copay.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $50 every three months, but acupuncture, meal benefits, and several other services are not covered.
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