Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)
H4093-001 • 2026 • Butler County, PA
Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 • 2026 • Butler County, PA
Provider Partners Pennsylvania Advantage Plan is a Medicare Institutional plan offered by Provider Partners Health Plans for the 2026 plan year. It is identified by CMS Plan ID H4093-001 and serves individuals who meet defined eligibility criteria.
Provider Partners Pennsylvania Advantage Plan Overview
Plan Overview for H4093-001-0 | |
|---|---|
| CMS Plan ID: | H4093-001-0 |
| Plan Type: | HMO I-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $32.70 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: | Butler County, PA |
| Enrollment (Nationwide) | 761 beneficiaries |
| Enrollment (CMS – Local) | 61 beneficiaries in Butler County |
| Provided By: | Provider Partners Health Plans |
Plan Overview and Eligibility
- Provider Partners Pennsylvania Advantage Plan is a Medicare I-SNP plan for individuals who are institutionalized or require nursing care.
- This plan is for individuals living in a long-term care facility.
- To enroll, you must have Medicare Part A and Part B, live in the plan’s service area, and meet institutional or equivalent care requirements.
- This plan uses a {network_type} provider network for covered healthcare services.
- It replaces Original Medicare and includes Medicare Part D prescription drug coverage. The annual Part D deductible is $615.00.
- Benefits and care may be coordinated based on your care setting and needs.
- Extra Help may reduce prescription drug premiums, deductibles, and copayments for those who qualify.
Provider Partners Pennsylvania Advantage Plan operates on a Health Maintenance Organization (HMO) network. Members usually access care through in-network providers, and referrals are often needed for specialty services. The plan covers emergency services and out-of-area dialysis regardless of network status.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: 20% coinsurance |
| Specialist: | In-network: 20% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| 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 |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| 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 |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient 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 |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric 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 |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 20% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including 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 |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| 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 |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and 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 |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| 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 |
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: | $32.70 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $32.70 |
| Low Income Premium Subsidy: | $32.71 |
| Low Income Premium Subsidy CMS Pays: | $32.70 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug 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.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, Provider Partners Pennsylvania Advantage Plan has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Plan Star Ratings
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
CMS Star Ratings for Plan H4093-001-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 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 | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Provider Partners Health Plans
| 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 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- Provider Partners Health Plans (official source), http://www.pphealthplan.com — Last accessed April 30, 2026
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)" — Last accessed April 28, 2026
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed April 28, 2026
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed April 28, 2026
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