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TTY users 711
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Provider Partners Maryland Community Plan (HMO I-SNP)
Medicare Plan Details (2022 Plan)
Monthly Premium
by Provider Partners Health Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Ratingout of 5 stars
Ready to Enroll Online?
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
$37
$0
$37
$233 per year for in-network services.
$7,550 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
20% coinsurance per visit
20% coinsurance per visit
Tests, labs, & imaging
20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance per visit (always covered)
20% coinsurance per visit (always covered)
Hospital Services
In 2022 the amounts for each benefit period are:
$1,556 deductible for days 1 through 60
$389 copay per day for days 61 through 90
$1,556 deductible for days 1 through 60
$389 copay per day for days 61 through 90
20% coinsurance per visit
Skilled nursing facility
In 2022 the amounts for each benefit period are:
$0 copay for days 1 through 20
$194.50 copay per day for days 21 through 100
$0 copay for days 1 through 20
$194.50 copay per day for days 21 through 100
Preventive services
$0 copay
Ambulance
20% coinsurance
Therapy services
20% coinsurance
20% coinsurance
Mental health services
20% coinsurance
20% coinsurance
20% coinsurance
20% coinsurance
Opioid treatment services
Covered
Other services
20% coinsurance per item
20% coinsurance per item
20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic |
Brand-name drugs :
|
Brand-name drugs :
| |
| Generic | |||
| Preferred Brand | |||
| Non-Preferred Drug | |||
| Specialty Tier |
Part B Drugs
20% coinsurance
20% coinsurance
Extra Benefits
Hearing
20% coinsurance
$0 copay
$0 copay
$0 copay
$0 copay
Preventive Dental
$0 copay
$0 copay
$0 copay
$0 copay
Comprehensive dental
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Vision
$0 copay
$0 copay
Not covered
$0 copay
$0 copay
Not covered
Other benefits
Not covered
Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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TTY 711
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