Provider Partners Missouri Essential Plan (HMO I-SNP)
Missouri Institutional Special Needs I-SNP Plan (2025 Plan)
by Provider Partners Health Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
3.5
out of 5 stars
Plan Name
Provider Partners Missouri Essential Plan (HMO I-SNP)
Insurance Carrier
Provider Partners Health Plans
Plan Type
Institutional Special Needs Plan (I-SNP)
Provider Partners Missouri Essential Plan (HMO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in Missouri and offered by the health insurance company Provider Partners Health Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Annual Deductible
Coming soon
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
ER visit
20% coinsurance per visit (always covered)
Ambulance
20% coinsurance
Provider Partners Missouri Essential Plan (HMO I-SNP) has a monthly premium cost of $37 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Provider Partners Missouri Essential Plan (HMO I-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Provider Partners Missouri Essential Plan (HMO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Provider Partners Missouri Essential Plan (HMO I-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Provider Partners Missouri Essential Plan (HMO I-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Provider Partners Missouri Essential Plan (HMO I-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.
Provider Partners Missouri Essential Plan (HMO I-SNP) performed worse than Missouri’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
Missouri State Average Score
Overall Government 5 Star Quality Rating
3.5
3.8
Summary rating of health plan quality
Staying healthy: screenings, tests, & vaccines
Managing chronic (long term) conditions
Member experience with health plan
Member complaints & changes in the health plan's performance
Health plan customer service
Summary rating of drug plan quality
Drug plan customer service
Member complaints & changes in the drug plan's performance
Member experience with the drug plan
Drug safety & accuracy of drug pricing
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Provider Partners Missouri Essential Plan (HMO I-SNP) received 3 stars for its health plan quality score which is worse than the Missouri State average health plan quality score of 3.8 stars.
Provider Partners Missouri Essential Plan (HMO I-SNP) received 4 stars for its drug plan quality score which is better than the Missouri State average drug plan quality score of 3.7 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
20% coinsurance per visit (always covered)
Urgent care
20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
Outpatient hospital coverage
20% coinsurance per visit
Skilled nursing facility
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
Prosthetics (like braces, artificial limbs)
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
Generic |
Preferred Brand |
Non-Preferred Drug |
Specialty Tier |
Part B Drugs
Hearing
Hearing aids - Over the ear
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
Vision
Eyeglasses (frames & lenses)
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