Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Provider Partners Texas Advantage Plan, 2027
H4054Contract001Plan
HMO I-SNP · special needs plan, institutional · 86 counties in Texas
Run by Provider Partners Health Plan of Texas, Inc. (contract H4054), sold as Provider Partners Health Plans, owned by Rifkin Managed Care Holding, LLC
Provider Partners Texas Advantage Plan (H4054-001) costs $6.30 a month in 2027, up $1.50 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026). It leaves 8 counties it served in 2026; they choose another plan for 2027 (the counties are listed below).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $4.80 | $6.30 | ▲up $1.50 |
| In-network out-of-pocket limit | $9,250 | $9,850 | ▲up $600 |
| Drug deductible | $615 | $700 | ▲up $85 |
| Counties served | 85 | 86 | ▲up 1 |
| 12 lines do not change | |||
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | 20% of the cost | 20% of the cost | no change |
| Specialist visit | 20% of the cost | 20% of the cost | no change |
| Emergency room | 20% of the cost | 20% of the cost | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | not filed | not filed | no change |
| Skilled nursing facility, in network | $0 a stay | $0 a stay | no change |
| Ground ambulance, in network | 20% of the cost | 20% of the cost | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Eyewear, yearly limit | $150 a year | $150 a year | no change |
| Hearing aids, yearly limit for both ears | $1,000 a year | $1,000 a year | no change |
| Over-the-counter items, yearly | $280 a year | $280 a year | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
How does it compare with plans sold where it is?
In the counties it serves, 7 institutional special needs plans are sold for 2027, this one included. Against the others, 2 plans have a lower out-of-pocket limit, 4 the same. On the premium, 4 plans have a lower premium, 2 the same.
Out-of-pocket limits of the 7 institutional special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
It stops serving 8 counties it served in 2026 (listed in the next section).
The premium and the out-of-pocket limit are the same in all 86 counties: $6.30 a month and $9,850.
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
What if you live in a county it leaves?
Its 2026 members in the 8 counties listed below cannot stay in it for 2027; each county page lists the 2027 plans sold there.
- Your coverage
- This plan ends for you on December 31, 2026, because it is no longer sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, without a drug plan unless you join one (with Extra Help or full Medicaid, Medicare enrolls you in one).
- Without a drug plan
- Going 63 days or more in a row without drug coverage can mean a late enrollment penalty if you join a drug plan later; joining by the end of February keeps a January and February gap under 63 days, waiting longer does not.
- If you choose Original Medicare
- You have a guaranteed right to buy Medigap Plan A, B, C, D, F, G, K or L sold in your state by any insurance company; if you were new to Medicare on or after January 1, 2020, Plans D and G take the place of C and F. Apply from 60 days before to 63 days after the plan ends; the policy starts once your Medicare Advantage coverage ends. Other Medigap plans are not covered by this right.
| County | Members, Sept. 2026 |
|---|---|
| Cass, TX | fewer than 11 |
| Crane, TX | fewer than 11 |
| Hamilton, TX | fewer than 11 |
| Lavaca, TX | fewer than 11 |
| Midland, TX | fewer than 11 |
| Red River, TX | fewer than 11 |
| Shelby, TX | fewer than 11 |
| Waller, TX | fewer than 11 |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); Medicare.gov, “Special enrollment periods” and “When can I buy Medigap?” (read Oct. 7, 2026).
Who runs this plan?
- Plan ID
- H4054-001
- Legal name of the contract
- Provider Partners Health Plan of Texas, Inc.
- Sold as
- Provider Partners Health Plans
- Parent company
- Rifkin Managed Care Holding, LLC
- Plan type
- HMO I-SNP
- 2026 star rating of the contract
- 5 of 5 overall; health plan 4.5 of 5, drug plan 4 of 5
- Members, September 2026
- 2,557
- Plan website, as filed with CMS
- www.pphealthplan.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in El Paso, TXWhere most of its members live; premiums and limits side by side
- Every Provider Partners Health Plans plan for 2027Its contracts, counties and plans that end
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.