Provider Partners Texas Advantage Plan (HMO I-SNP) H4054-001 • 2027 • Palo Pinto County, TX
- 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
- Palo Pinto County, TX
- Local Enrollment
- 27 beneficiaries in Palo Pinto County
Introduction
CMS Plan ID H4054-001 identifies Provider Partners Texas Advantage Plan, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Provider Partners Health Plans. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has 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.
Qualifying residents of Palo Pinto County, Texas may enroll in this plan. CMS reports 27 beneficiaries enrolled in this plan in Palo Pinto County. New members can call the plan directly at (800)405-9681 (TTY 711) for assistance.
Eligibility
Provider Partners Texas Advantage Plan is a Facility-based Institutional (FI-SNP) plan designed for individuals who need nursing-level care.
- 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.
Compare Similar Plans in Palo Pinto County
Compare this plan with the two most-enrolled HMO I-SNP plans available in Palo Pinto County, Texas. Enrollment is based on CMS local enrollment data.
| Plan Detail | Provider Partners Texas Advantage Plan | Texas Independence Health Plan, Inc. | Texas Independence Community Plan |
|---|---|---|---|
| CMS Plan ID | H4054-001-0 |
H5015-001-0 |
H5015-002-0 |
| Local Enrollment | 27 | 0 | 0 |
| Monthly Premium | $6.30 | $3.90 | $6.30 |
| Medical Deductible | Coming soon | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,850.00 | $9,250.00 | $9,250.00 |
| Part B Giveback | Coming soon | Not offered | Not offered |
| Primary Care | Coming soon | 20% coinsurance | 20% coinsurance |
| Specialist | Coming soon | 20% coinsurance | 20% coinsurance |
| Part D Deductible | $700.00 | $700.00 | $700.00 |
| CMS Star Rating | 4.0 | 4.5 | 4.5 |
| Dental | Coming soon | $0 copay | $0 copay |
| Vision | Coming soon | $0 copay | $0 copay |
| Hearing | Coming soon | $0 copay | $0 copay |
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.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4054-001-0 Cost Compare.
Office Visits
- Primary care
- Coming soon
- Specialist
- Coming soon
Preventive and Wellness Services
- Annual wellness exam
- Coming soon
- Telehealth benefit
- Coming soon
- Routine chiropractic
- Coming soon
- Fitness benefits
- Coming soon
- Health education
- Coming soon
- Counseling services
- Coming soon
- Over-the-counter drug benefits
- Coming soon
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- Coming soon
- Lab services
- Coming soon
- Outpatient x-rays
- Coming soon
- Diagnostic tests and procedures
- Coming soon
Emergency and Urgent Care Services
- Emergency room care
- Coming soon
- Worldwide emergency care
- Coming soon
- Urgent care
- Coming soon
- Inpatient hospital care
- Coming soon
- Skilled Nursing Facility
- Coming soon
- Ground ambulance
- Coming soon
Mental Health Services
- Outpatient individual therapy
- Coming soon
- Outpatient group therapy
- Coming soon
- Inpatient psychiatric hospital care
- Coming soon
Rehabilitation Services
- Physical therapy and speech and language therapy
- Coming soon
- Occupational therapy
- Coming soon
Medical Equipment and Supplies
- Diabetes supplies
- Coming soon
- Durable medical equipment
- Coming soon
- Prosthetics
- Coming soon
Medicare Part B Drugs
- Chemotherapy
- Coming soon
- Other Part B drugs (Medicare-covered)
- Coming soon
Dental Services
- Oral exam
- Coming soon
- Dental x-rays
- Coming soon
- Cleaning
- Coming soon
- Periodontics
- Coming soon
- Endodontics
- Coming soon
- Restorative services
- Coming soon
- Implant services
- Coming soon
- Orthodontics
- Coming soon
- Oral/Maxillofacial surgery
- Coming soon
Vision Services
- Routine eye exam
- Coming soon
- Contact lenses
- Coming soon
- Eyeglass frames only
- Coming soon
- Eyeglass lenses only
- Coming soon
- Eyeglasses (frames & lenses)
- Coming soon
- Upgrades
- Coming soon
Hearing Services
- Hearing exam
- Coming soon
- Fitting/evaluation
- Coming soon
- Prescription hearing aids
- Coming soon
- OTC hearing aids
- Coming soon
Additional and Special Needs Services
- Adult day health services
- Coming soon
- Home-based palliative care
- Coming soon
- Personal emergency response system
- Coming soon
- Weight management programs
- Coming soon
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Coming soon
- Massage therapy
- Coming soon
- Home/bathroom safety devices
- Coming soon
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)
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 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.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
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 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under 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.