Provider Partners Missouri Essential Plan (HMO I-SNP)
Available to residents of Dent County, MO for 2026. Contract H9191, plan 005, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Dent County
- Plan website
- Browse the Provider Partners Missouri Essential Plan (HMO I-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $43.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $43.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO I-SNP? |
| Special needs plan | Institutional SNP |
| Contract / plan | H9191-005-0 |
| Offered by | Provider Partners Health Plans |
| Parent organization | Rifkin Managed Care Holding, LLC |
| Formulary drugs | 3,321 |
| Pharmacy search | www.pphealthplan.com |
| Member services | (800)405-9681TTY 711 |
CMS star ratings
- Overall
- 4.5 out of 5 stars for Overall
- Health plan (Part C)
- 4.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H9191 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | 20% coinsurance |
| Specialist | 20% coinsurance |
| Other health care professional | 0%–20% coinsurance |
| Additional telehealth services | 20% coinsurance |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | 20% coinsurance |
| Kidney disease education | 20% coinsurance |
| Glaucoma screening | 20% coinsurance |
| Diabetes self-management training | 20% coinsurance |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 20% coinsurance(authorization required) |
| Lab services | 20% coinsurance(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 20% coinsurance |
| Therapeutic radiology | 20% coinsurance |
| Outpatient x-rays | 20% coinsurance |
| Emergency and urgent care | |
| Emergency room | 20% coinsurance |
| Urgent care | 20% coinsurance |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | Original Medicare cost-sharing(authorization required) |
| Outpatient hospital services | 20% coinsurance(authorization required) |
| Outpatient observation | 20% coinsurance |
| Ambulatory surgical center | 20% coinsurance(authorization required) |
| Outpatient blood services | 20% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | Original Medicare cost-sharing(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | 20% coinsurance(authorization required) |
| Physical therapy and speech-language therapy | 20% coinsurance(authorization required) |
| Cardiac rehabilitation | 20% coinsurance(authorization required) |
| Pulmonary rehabilitation | 20% coinsurance(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | Original Medicare cost-sharing(authorization required) |
| Outpatient mental health, individual session | 20% coinsurance |
| Outpatient mental health, group session | 20% coinsurance |
| Psychiatrist, individual session | 20% coinsurance |
| Psychiatrist, group session | 20% coinsurance |
| Partial hospitalization | 20% coinsurance(authorization required) |
| Intensive outpatient program | 20% coinsurance(authorization required) |
| Outpatient substance use, individual session | 20% coinsurance(authorization required) |
| Outpatient substance use, group session | 20% coinsurance(authorization required) |
| Opioid treatment program | 20% coinsurance(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | 20% coinsurance |
| Air ambulance | 20% coinsurance |
| Transportation to plan-approved locations | $0 copay |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 20% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | 20% coinsurance |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | 20% coinsurance |
| Routine foot care | $0 copay(limits apply) |
| Dental? | |
| Medicare-covered dental services | 20% coinsurance |
| Preventive dental plan limit | $3,000 plan limit every year |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | $0 copay(limits apply) |
| Other preventive dental services | $0 copay(limits apply) |
| Restorative services (fillings, crowns) | $0 copay |
| Endodontics (root canals) | $0 copay |
| Periodontics (gum disease) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay |
| Maxillofacial prosthetics | $0 copay |
| Implants | $0 copay |
| Bridges and other fixed prosthodontics | $0 copay |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | $0 copay |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | 20% coinsurance |
| Routine eye exam | 0% coinsurance(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | 20% coinsurance(limits apply) |
| Eyewear plan limit | $300 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | 20% coinsurance |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aid plan limit | $2,000 plan limit every two years |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | $0 copay(limits apply) |
| Hearing aids, outer ear | $0 copay(limits apply) |
| Hearing aids, over the ear | $0 copay(limits apply) |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $170 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | Not covered |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | 0% | 0% | 0% | 0% | 0% | 0% |
Also available in 64 other MO counties
- Audrain
- Barry
- Boone
- Butler
- Caldwell
- Callaway
- Camden
- Cape Girardeau
- Carroll
- Cedar
- Chariton
- Christian
- Clay
- Clinton
- Cole
- Crawford
- Dade
- Dallas
- DeKalb
- Douglas
- Franklin
- Greene
- Henry
- Hickory
- Howard
- Iron
- Jackson
- Jasper
- Jefferson
- Laclede
- Lafayette
- Lawrence
- Lincoln
- Livingston
- McDonald
- Madison
- Maries
- Miller
- Mississippi
- Moniteau
- Montgomery
- New Madrid
- Phelps
- Platte
- Polk
- Pulaski
- Ray
- Reynolds
- Ripley
- St. Charles
- St. Francois
- St. Louis
- St. Louis City
- Saline
- Scott
- Stoddard
- Stone
- Taney
- Texas
- Vernon
Benefits in plain text
Provider Partners Missouri Essential Plan (HMO I-SNP) (H9191-005-0) is a 2026 HMO I-SNP Medicare Advantage plan offered by Provider Partners Health Plans, available to residents of Dent County, MO.
The monthly premium is $43.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00.
It is a special needs plan (Institutional SNP).
The plan's formulary lists 3,321 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: 25%.
CMS gives the plan's contract (H9191) an overall rating of 4.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.