Provider Partners Missouri Essential Plan (I-SNP) Plan Details for Chariton County, MO
This page provides coverage and cost details for Provider Partners Health Plans’s H9191-005-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this Provider Partners Health Plans plan (H9191-005-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Institutional SNP qualification requirements to join this I-SNP plan.
Provider Partners Missouri Essential Plan Basic Plan Details
- Plan ID
- H9191-005-0
- Plan Type
- HMO I-SNP
- Plan Year
- 2025
- Premium
- $37.20/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Basic
$590.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Chariton County, MO
- Insured By
- Provider Partners Health Plans
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
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:
Doctor's Office Visits
- Primary
- 20% Coinsurance
- Specialist
- 20% Coinsurance
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- 20% Coinsurance
- Urgent care
- 20% Coinsurance
- Ground ambulance
- 20% Coinsurance
- Inpatient hospital care
- Skilled Nursing Facility
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- 20% Coinsurance
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- 20% Coinsurance
- Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- 20% Coinsurance
- Outpatient group therapy
- 20% Coinsurance
- Inpatient psychiatric hospital care
Rehabilitation Services
- Physical therapy and speech and language therapy
- 20% Coinsurance
Prior Authorization Required - Occupational therapy
- 20% Coinsurance
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- 20% Coinsurance
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- 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
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $3,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- 20% Coinsurance
- Routine eye exam
- 0% Coinsurance
1 Every year - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Provider Partners Missouri Essential Plan includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $37.20 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Provider Partners Health Plans begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Provider Partners Missouri Essential Plan has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Provider Partners Health Plans plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Provider Partners Missouri Essential Plan
To be eligible to enroll in Provider Partners Missouri Essential Plan , you must meet three requirements:
- You are eligible for Medicare;
- You live in Chariton County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining Provider Partners Missouri Essential Plan , consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Provider Partners Health Plans
| Website: | Provider Partners Health Plans Plan Page (opens in new tab) |
|---|---|
| Providers: | Provider Partners Health Plans Providers Page (opens in new tab) |
| Formulary: | Provider Partners Health Plans Formulary Page (opens in new tab) |
| Pharmacy: | Provider Partners Health Plans Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (800)405-9681 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)405-9681 |
| New Member Part D 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
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold a Medigap Insurance policy at the same time.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- Provider Partners Health Plans, http://www.pphealthplan.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Missouri", 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
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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