Provider Partners Maryland Advantage Plan (I-SNP) Plan Details for Talbot County, MD
Many of the plans featured here are available through our partner, HealthCompare, who may compensate us when you enroll in a plan. This does not influence our evaluations. Our opinions are our own, based on our independent research. Learn more about how we make money.
*This plan is new and has not yet been rated by CMS.
Provider Partners Maryland Advantage Plan (I-SNP) is a Institutional Medicare Advantage Special Needs Plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin J
This plan is required to provide all of the same benefits as Original Medicare, but out-of-pocket costs are different. This private health insurance option may include extra benefits not covered by Medicare Part A or Part B.
Eligible individuals must meet all Institutional SNP qualification requirements to join this Provider Partners Health Plans I-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H8067-001-0 |
| Plan Type: | HMO I-SNP |
| Plan Year: | 2025 |
| Premium: | $46.30/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 9,350.00 /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | $590.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Talbot County, MD |
| Insured By: | Provider Partners Health Plans |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Provider Partners Health Plans plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | 20% Coinsurance |
| Specialist: | 20% Coinsurance Prior Authorization Required |
| Preventive care: | 20% Coinsurance |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | 20% Coinsurance |
| Routine foot care: | $0 |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | 20% Coinsurance |
| Routine chiropractic care: | $0 |
| Emergency Care / Urgent Care | |
| Emergency room care: | 20% Coinsurance |
| Urgent care: | 20% Coinsurance |
| Ground ambulance: | 20% Coinsurance |
| Inpatient hospital coverage: | |
| Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required |
| Skilled Nursing Facility: | Unknown |
| Optional supplemental benefits: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
| Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
| Inpatient hospital - psychiatric: | |
| Outpatient group therapy visit: | 20% Coinsurance |
| Outpatient individual therapy visit: | 20% Coinsurance Prior Authorization Required |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | $0 |
| Occupational therapy visit: | $0 |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required |
| Lab services: | 20% Coinsurance Prior Authorization Required |
| Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Provider Partners Maryland Advantage Plan Summary of Benefits information.
Supplemental Health Plan Benefits (H8067-001-0)
The following is a summary of the supplemental benefits Provider Partners Health Plans includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| Preventive Dental | |
| Oral exam (In-Network) | Not Covered |
| Fluoride treatment (In-Network) | Not Covered |
| Dental x-ray(s) (In-Network) | Not Covered |
| Cleaning (In-Network) | Not Covered |
| Comprehensive Dental | |
| Periodontics (In-Network) | Not Covered |
| Non-routine services (In-Network) | Not Covered |
| Diagnostic services (In-Network) | Not Covered |
| Extractions (In-Network) | Not Covered |
| Endodontics (In-Network) | Not Covered |
| Restorative services (In-Network) | Not Covered |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
| Hearing | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Not Covered |
| Hearing exam (In-Network) | Covered Limits may apply |
| Vision | Maximum vision benefit: | $2.00 Every three years |
| Eyeglasses (frames and lenses) (In-Network) | Not Covered |
| Routine eye exam (In-Network) | 0% Coinsurance |
| Contact lenses (In-Network) | Not Covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the details of this plan's prescription drug plan premium.
| Basic Part D Premium: | |
| Supplemental Part D Premium: | |
| Total Part D Premium: | |
| Part D Premium with Full LIS Assistance: |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Provider Partners Health Plans begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Provider Partners Maryland Advantage Plan has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage I-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Provider Partners Health Plans plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing | Not enough data available |
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Provider Partners Maryland Community Plan
- Provider Partners Maryland Essential Plan
- Provider Partners Maryland Advantage Plan
Contact Provider Partners Health Plans
| Plan Website: | http://www.pphealthplan.com |
|---|---|
| Formulay Information: | http://www.pphealthplan.com |
| Pharmacy Information: | Provider Partners Health Plans Pharmacy Page |
| Prospective Members: | (800)405-9681 |
| TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Provider Partners Health Plans, http://www.pphealthplan.com, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Maryland", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.