Provider Partners Pennsylvania Community Plan (HMO I-SNP) By Provider Partners Health Plans

Provider Partners Pennsylvania Community Plan (HMO I-SNP) is a 2022 Medicare Advantage Special Needs Plan plan by Provider Partners Health Plans. This plan from Provider Partners Health Plans works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Provider Partners Health Plans and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.

2022 Medicare Special Needs Plan Details

The Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Provider Partners Pennsylvania Community Plan (HMO I-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Provider Partners Health Plans plan offer additional coverage through the gap.

Provider Partners Pennsylvania Community Plan (HMO I-SNP) Part-C Premium

Provider Partners Health Plans plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H4093-004 Part-D Deductible and Premium

Provider Partners Pennsylvania Community Plan (HMO I-SNP) has a monthly drug premium of $40.70 and a $480.00 drug deductible. This Provider Partners Health Plans plan offers a $40.70 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Provider Partners Health Plans above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $40.70 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Provider Partners Health Plans Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Provider Partners Health Plans plan offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Provider Partners Pennsylvania Community Plan (HMO I-SNP) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.20 for 75% low income subsidy $20.30 for 50% and $30.50 for 25%.

H4093-004 Formulary or Drug Coverage

Provider Partners Pennsylvania Community Plan (HMO I-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	25%

*Initial Coverage Phase and 30 day supply

Coverage Area for Provider Partners Pennsylvania Community Plan (HMO I-SNP)

Source: CMS.

Plans as of September 1, 2021.

Notes: Data are subject to change. All contracts for 2022 have not been finalized. For 2022, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2022 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.