Provider Partners Texas Advantage Plan (HMO I-SNP) Medicare Special Need Plan H4054-001 • 2027
- Monthly Premium
- $6.30Plus Part B premium.
- Medical Deductible
- Coming soon
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Coming soon
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- None
- Service Area
- See List
- Total Enrollment
- 2,437 beneficiaries
Introduction
Provider Partners Texas Advantage Plan, offered by Provider Partners Health Plans, is a Medicare Advantage Institutional Special Needs Plan (I-SNP) identified by CMS Plan ID H4054-001. The plan's Health Maintenance Organization (HMO) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $6.30 monthly premium, Coming soon medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
This plan has 2,437 beneficiaries enrolled across its service areas based on CMS enrollment data. To enroll, you must live within the plan's service area: See List.
Eligibility
- Special Needs Plan Type
- Institutional Special Needs Plan (I-SNP)
- Medicare Requirement
- Must have 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 service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
Provider Partners Texas Advantage Plan has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4054-001.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | Coming soon | In-network: 20% coinsurance |
| Specialist | Coming soon | In-network: 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Coming soon | In-network: 20% coinsurance |
| Telehealth benefit | Coming soon | In-network: 20% coinsurance |
| Routine chiropractic | Coming soon | Not covered |
| Fitness benefits | Coming soon | Not covered |
| Health education | Coming soon | Not covered |
| Counseling services | Coming soon | Not covered |
| Over-the-counter drug benefits | Coming soon | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | Coming soon | In-network: 20% coinsurance |
| Lab services | Coming soon | In-network: 20% coinsurance |
| Outpatient x-rays | Coming soon | In-network: 20% coinsurance |
| Diagnostic tests and procedures | Coming soon | In-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | Coming soon | 20% coinsurance |
| Worldwide emergency care | Coming soon | Not covered |
| Urgent care | Coming soon | 20% coinsurance |
| Inpatient hospital care | Coming soon | 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 | Coming soon | Tier 1 Tier 2 $0 copay |
| Ground ambulance | Coming soon | In-network: 20% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | Coming soon | In-network: 20% coinsurance |
| Outpatient group therapy | Coming soon | In-network: 20% coinsurance |
| Inpatient psychiatric hospital care | Coming soon | 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
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | Coming soon | In-network: $0 copay |
| Occupational therapy | Coming soon | In-network: $0 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | Coming soon | In-network: 20% coinsurance |
| Durable medical equipment | Coming soon | In-network: 20% coinsurance |
| Prosthetics | Coming soon | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | Coming soon | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | Coming soon | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Coming soon | In-network: $0 copay |
| Dental x-rays | Coming soon | In-network: $0 copay |
| Cleaning | Coming soon | In-network: $0 copay |
| Periodontics | Coming soon | In-network: $0 copay |
| Endodontics | Coming soon | In-network: $0 copay |
| Restorative services | Coming soon | In-network: $0 copay |
| Implant services | Coming soon | In-network: $0 copay |
| Orthodontics | Coming soon | In-network: $0 copay |
| Oral/Maxillofacial surgery | Coming soon | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Coming soon | In-network: 0% coinsurance |
| Contact lenses | Coming soon | In-network: $0 copay |
| Eyeglass frames only | Coming soon | In-network: $0 copay |
| Eyeglass lenses only | Coming soon | In-network: $0 copay |
| Eyeglasses (frames & lenses) | Coming soon | Not covered |
| Upgrades | Coming soon | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Coming soon | In-network: $0 copay |
| Fitting/evaluation | Coming soon | In-network: $0 copay |
| Prescription hearing aids | Coming soon | Not covered |
| OTC hearing aids | Coming soon | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Coming soon | Not covered |
| Home-based palliative care | Coming soon | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Coming soon | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Coming soon | Not covered |
| Massage therapy | Coming soon | Not covered |
| Home/bathroom safety devices | Coming soon | Not covered |
Certain preventive services are covered 100% by Provider Partners Texas Advantage Plan as a Part B benefit.
Prescription Drug Coverage
Provider Partners Texas Advantage Plan includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $6.30 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $6.30 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $6.30 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Provider Partners Health Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Provider Partners Texas Advantage Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | Not available | 25% coinsurance |
| Generic drugs | Not available | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4054)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Provider Partners Health Plans
- Website
- Provider Partners Health Plans Plan Page
- Providers
- Provider Partners Health Plans Providers Page
- Formulary
- Provider Partners Health Plans Formulary Page
- Pharmacy
- Provider Partners Health Plans Pharmacy Page
- New Member Health Plan Help
- (800)405-9681
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)405-9681
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Provider Partners Texas Advantage Plan (H4054-001-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Provider Partners Health Plans (official source) | http://www.pphealthplan.com | October 4, 2026 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.