Provider Partners Missouri Essential Plan (HMO I-SNP)

Missouri Institutional Special Needs I-SNP Plan (2025 Plan)


Monthly Premium

Your Cost
$37
by Provider Partners Health Plans

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Name
Provider Partners Missouri Essential Plan (HMO I-SNP)
Insurance Carrier
Provider Partners Health Plans
Plan Type
Institutional Special Needs Plan (I-SNP)
Network Type
HMO

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.

Monthly Premium
$37
Annual Deductible
Coming soon
Max Out-of-Pocket
$9,350
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
Yes
Dental
Yes
Vision
Yes
Hearing

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

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

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
 3
 3.8
Staying healthy: screenings, tests, & vaccines
 2
 3.7
Managing chronic (long term) conditions
 4
 3.5
Member experience with health plan
(coming soon)
 3.8
Member complaints & changes in the health plan's performance
 4
 3.8
Health plan customer service
 2
 4.0
Summary rating of drug plan quality
 4
 3.7
Drug plan customer service
 3
 4.0
Member complaints & changes in the drug plan's performance
 4
 3.6
Member experience with the drug plan
(coming soon)
 4.1
Drug safety & accuracy of drug pricing
 4
 3.2

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.


Monthly Premium
$37
Health Portion of Premium
$0
Drug Portion of Premium
$37
Health Plan Deductible
Coming soon
Health Plan Max Out-of-Pocket
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
20% coinsurance
Lab services
20% coinsurance
Diagnostic radiology services (like MRI)
20% coinsurance
Outpatient x-rays
20% coinsurance
Emergency care
20% coinsurance per visit (always covered)
Urgent care
20% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage
Coming soon
Outpatient hospital coverage
20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
Coming soon

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
20% coinsurance

Therapy services

Occupational therapy visit
20% coinsurance
Physical therapy & speech & language therapy visit
20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
20% coinsurance
Outpatient individual therapy with a psychiatrist
20% coinsurance
Outpatient group therapy visit
20% coinsurance
Outpatient individual therapy visit
20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic 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

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
20% coinsurance
Fitting/evaluation
$0 copay
Hearing aids - Inner ear
$0 copay
Hearing aids - Outer ear
$0 copay
Hearing aids - Over the ear
$0 copay

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
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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