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Provider Partners Missouri Essential Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Provider Partners Missouri 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 Missouri Essential Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Provider Partners Missouri 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 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 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 Missouri 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 Missouri 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 Missouri Essential Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.20. 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 $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 Essential Plan (HMO I-SNP)
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Drug Coverage
The Provider Partners Missouri Essential Plan (HMO I-SNP) has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $37.20. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Provider Partners Missouri Essential Plan (HMO I-SNP) offers a range of benefits, including inpatient and outpatient hospital services, with a 20% coinsurance for many services. The plan also covers primary care, preventive services, hearing, vision, and dental services. This plan includes specific cost-sharing details such as a 20% coinsurance for services like outpatient services, emergency services, and ambulance services. There is no copay for home health services. The plan also offers additional benefits like coverage for medical equipment, and diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. The cost share for tier 1 services is the same as Original Medicare.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital and observation services have a 20% coinsurance, while ambulatory surgical center services and outpatient substance abuse services also have a 20% coinsurance for individual and group sessions. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Provider Partners Missouri Essential Plan (HMO I-SNP). Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to any health-related location are covered for 14 one-way trips per year.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Provider Partners Missouri Essential Plan (HMO I-SNP), with a 20% coinsurance. Worldwide emergency services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with a 20% coinsurance for many services. Routine Chiropractic Care is not covered.
Preventive Services See details
The Provider Partners Missouri Essential Plan (HMO I-SNP) covers preventive services, including Medicare-covered zero dollar preventive services with no cost-sharing. Annual physical exams are covered with 20% coinsurance, and additional preventive services are not covered, including health education, in-home safety assessments, and many others. Kidney disease education services, glaucoma screening, barium enemas, digital rectal exams, and EKG following Welcome Visit, all have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a coinsurance of at most 20% and no deductible, with one routine exam covered per year, and fitting/evaluation for hearing aids is covered for 4 visits every two years. Prescription hearing aids are covered, with a maximum benefit of $1000 every two years; however, prescription hearing aids (all types) are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and routine eye exams with no coinsurance. Eyewear benefits include contact lenses with 20% coinsurance and a combined maximum of $150 per year, while eyeglass lenses and frames are covered. Eyeglass frames and eyeglass lenses are unlimited. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services and a $3,000 maximum benefit per year for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, each limited to one visit per year. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered. Adjunctive General Services are not covered.
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 Essential Plan (HMO I-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. For DME, there is a 20% coinsurance and authorization is required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts all 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 each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Provider Partners Missouri Essential Plan (HMO I-SNP). The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan follows Original Medicare for SNF services, and does not cover additional days beyond Medicare-covered, nor non-Medicare-covered stays.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, with a maximum benefit of $50.00 every three months; acupuncture, meal benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), 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 are not covered.
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