Provider Partners Missouri Essential Plan (HMO I-SNP) Costs & Coverage, Iron County, Missouri
Provider Partners Missouri Essential Plan (HMO I-SNP) Costs & Coverage, Iron County, Missouri
Discover how Provider Partners Missouri Essential Plan (HMO I-SNP) stands out as a 2026 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Provider Partners Health Plans are different than Original Medicare. This private health insurance option, available to qualified individuals in Iron County, MO, may include additional benefits that are not provided by Medicare Part A and Part B.
As of May 31, 2025, plan enrollments topped 0 members, with 0 in Iron County, Missouri.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Provider Partners Health Plans logo is a registered trademark.[2]
Provider Partners Missouri Essential Plan Overview
| Plan ID H9191-005-0 Overview | |
|---|---|
| Health Plan ID: | H9191-005-0 |
| Medicare Advantage Plan Type: | HMO I-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $43.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Iron County, MO |
| Insured By: | Provider Partners Health Plans |
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
Provider Partners Missouri Essential Plan is a Health Maintenance Organization (HMO) plan. As an HMO member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Provider Partners Missouri Essential Plan does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: 20% coinsurance |
| Specialist: | In-network: 20% coinsurance |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: 20% coinsurance |
| Telehealth benefit: | In-network: 20% coinsurance |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | 20% coinsurance |
| Wordwide emergency care: | Not covered |
| Urgent care: | 20% coinsurance |
| Inpatient hospital care: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100 |
| Ground ambulance: | In-network: 20% coinsurance |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: 20% coinsurance |
| Outpatient group therapy: | In-network: 20% coinsurance |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150 |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: 20% coinsurance |
| Occupational therapy: | In-network: 20% coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: 20% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: 20% coinsurance |
| Lab services: | In-network: 20% coinsurance |
| Outpatient x-rays: | In-network: 20% coinsurance |
| Diagnostic tests and procedures: | In-network: 20% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | In-network: $0 copay |
| Orthodontics: | In-network: $0 copay |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | Not covered |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: 0% coinsurance |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H9191-005-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $43.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $43.00 |
| Low Income Premium Subsidy: | $43.03 |
| Low Income Premium Subsidy CMS Pays: | $43.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Provider Partners Health Plans begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Provider Partners Missouri Essential Plan has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO I-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Provider Partners Health Plans plan.
CMS Star Ratings for Plan H9191-005-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Eligibility for Enrollment in Provider Partners Missouri Essential Plan
To enroll in Provider Partners Missouri Essential Plan, you must meet the following three criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You require the level of care typically provided in an institutional setting, such as a long-term care nursing facility, for 90 days or more.
This is an Institutional-Equivalent plan for individuals who need the level of care given in a facility who can remain at home, live in a group home setting, or an assisted living facility.
If you live at home and need a similar level of skilled care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Provider Partners Missouri Essential Plan, it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Provider Partners Health Plans
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Provider Partners Health Plans Plan Page |
| New Members: | 1-800-405-9681 |
| Existing Members: | 1-800-405-9681 |
| Plan Address: | 8820 Columbia 100 Parkway, Suite 430 | Columbia, MD 21045 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 15, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Provider Partners Health Plans, http://www.pphealthplan.com — Last accessed October 13, 2025
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)" — Last accessed September 20, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 5 May, 2025
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Page content managed by David Bynon, Medicare Analyst.