Provider Partners Texas Advantage Plan (HMO I-SNP) Costs & Coverage — Rockwall County, Texas
Provider Partners Texas Advantage Plan (HMO I-SNP) is a Institutional Medicare Special Needs Plan identified by CMS Plan-ID H4054-001-0 offered by Provider Partners Health Plans for the 2026 plan year.
The most recent CMS enrollment data shows an estimated 2,479 beneficiaries enrolled in this plan, with 21 in Rockwall County.
Provider Partners Texas Advantage Plan Overview
Plan Overview for
H4054-001-0
|
|
|---|---|
| CMS Plan ID: |
H4054-001-0
|
| Plan Type: | HMO I-SNP |
| Plan Year: | 2026 |
| Monthly Premium: |
$4.80
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Rockwall County, TX |
| Enrollment (Nationwide): | 2,479 beneficiaries |
| Enrollment (CMS – Local) | 21 beneficiaries in Rockwall County |
| Provided By: | Provider Partners Health Plans |
To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).
Medicare Plan Decision Resources
Eligibility and Plan Network
Eligibility Requirements
- Provider Partners Texas Advantage Plan is a Medicare I-SNP plan designed for individuals who require institutional or nursing-level care.
- This plan is for individuals living in a long-term care facility.
| Special Needs Plan Type: | Institutional Special Needs Plan (I-SNP) |
|---|---|
| Medicare Requirement: | Must have both Medicare Part A and Part B |
| Special Needs Requirement: | This plan is for individuals living in a long-term care facility. |
| Service Area Requirement: | Must live in the plan's designated service area |
| Prescription Drug Coverage: | Prescription drug coverage is included. |
Plan Network
This plan uses a Health Maintenance Organization (HMO) network, meaning covered services are primarily provided by in-network doctors and facilities. Referrals are typically required for specialist care. Emergency services and out-of-area dialysis are covered outside the network.
5-Star Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage HMO I-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Provider Partners Health Plans plan.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| 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 |
Covered Services & Costs
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: 20% coinsurance |
| Specialist: | In-network: 20% coinsurance |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | 20% coinsurance |
| Worldwide 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 | Tier 2 | $0 copay |
| Ground ambulance: | In-network: 20% coinsurance |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 20% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Vision Services
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
Hearing Services
Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | Not covered |
| OTC hearing aids: | Not covered |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| 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-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Provider Partners Texas Advantage Plan covers 100% of certain preventive services as a required Part B benefit.
Prescription Drug Coverage
Part D Coverage Level (Benefit Design)
Provider Partners Texas Advantage Plan includes a basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $4.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $4.80 |
| Low Income Premium Subsidy: | $4.82 |
| Low Income Premium Subsidy CMS Pays: | $4.80 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
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.
Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Provider Partners Texas Advantage 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. | ||
Contact Provider Partners Health Plans
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) 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 |
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | 202608 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-08 |
| Publisher | Reference | Last Accessed |
|---|---|---|
| Provider Partners Health Plans (official source) | http://www.pphealthplan.com | October 13, 2025 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | September 20, 2025 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 5 May, 2025 |
Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.
Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.
Medicare plan data and editorial content curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for Medicare plan interpretation and publication.