Simpra Advantage

Simpra Advantage (PPO SNP) members receive more benefits than those covered by Original Medicare. Each member receives a personalized care plan, led by their nurse-practitioner and care team. There are two available plans: an Institutional Special Needs Plan (I-SNP) and a Dual-Eligible Special Needs Plan (D-SNP). Both plans cover all Medicare Part A and Part B benefits, plus Medicare Part D Prescription Drug Coverage and additional supplemental benefits. If you or your loved one is eligible, the Simpra Advantage may be the extra benefit you need to enhance your well-being.

You have choices with Simpra Advantage

ISNP

The Institutionalized Special Needs Plan (ISNP) is for beneficiaries who have both Medicare Part A and Part B and live in a participating nursing facility. You must live or expect to live, as determined by the state, in a participating nursing facility for 90 days or more.

DSNP

The Dual Eligible Special Needs Plan (DSNP) is for beneficiaries who are eligible for both Medicare and Medicaid.

Membership Advantages

  • A nurse practitioner-led team who will coordinate your care and develop your care plan
  • 24/7 member access to nurse practitioners while in a participating facility
  • Preventative services
  • Part D Prescription Drug Coverage
  • Nurse practitioners will come to nursing facilities to provide treatment
  • Supplemental hearing, vision, and routine foot care benefits provided at no extra cost to you (varies with plan type selected)

Benefit Highlights

ISNP Benefits

2018

How much is the monthly premium?
$30.60 per month. In addition, you must keep paying your Medicare Part B premium.

How much is the deductible?
$183 per year for in-network services.
$405 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

  • $6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

Benefits Coverage
Primary Care Physician (PCP) Visits 20% Coinsurance
Routine Foot Care $0 Copay for 2 additional routine podiatry visits per year
Hearing $0 Copay for routine hearing exam, hearing aid fitting, and evaluation + up to $1,600 for hearing aids every two years
Vision $0 Copay for routine eye exam every year + up to $275 for eyewear every year
Skilled Nursing $0 Coinsurance for days 1-100 days in a Skilled Nursing Facility (SNF) stay. No prior hospitalization required for a skilled nursing stay

2019

How much is the monthly premium?
$31.40 per month. In addition, you must keep paying your Medicare Part B premium.

How much is the deductible?
$183 per year for in-network services. This may change for 2019.
$415 deductible per year for Part D prescription drugs. This may change for 2019.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

  • $6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

Benefits Coverage
Primary Care Physician (PCP) Visit 20% Coinsurance
Routine Foot Care $0 Copay for 2 additional routine podiatry visits per year
Hearing $0 Copay for routine hearing exam, hearing aid fitting, and evaluation + up to $1,600 for hearing aids every two years
Vision $0 Copay for routine eye exam every year + up to $200 for eyewear every year
Skilled Nursing No prior hospitalization required for a skilled nursing stay

DSNP Benefits

2018

How much is the monthly premium?
$30.60 per month. In addition, you must keep paying your Medicare Part B premium.

How much is the deductible?
$183 per year for in-network services.
$405 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

  • $6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

Benefits Coverage
Primary Care Physician (PCP) Visit 20% Coinsurance
Vision $0 Copay for routine eye exam every two years + up to $175 for eyewear every year
Skilled Nursing $0 Coinsurance for days 1-100 days in a Skilled Nursing Facility (SNF) stay. No prior hospitalization required for a skilled nursing stay

2019

How much is the monthly premium?
$31.40 per month.

How much is the deductible?
$183 per year for in-network services. This may change for 2019.
$415 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?
Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.
Your yearly limit(s) in this plan:

  • $6,700 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.
Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply

Benefits Coverage
Primary Care Physician (PCP) Visit 20% Coinsurance
Vision $0 Copay for routine eye exam, 12 pairs of contact lenses/1 set of eyewear every year + up to $175 for eyewear every year
Skilled Nursing No prior hospitalization required for a skilled nursing stay

Simpra Advantage Management Statement

Simpra Advantage (PPO SNP) is a statewide, Alabama managed health care plan owned by SeniorSelect Partners, LLC, a consortium of 28 Alabama nursing home companies that own and manage over 100 Alabama nursing facilities. Simpra Advantage has contracted with a State-wide network of health care and social service providers which include physicians, hospitals, ancillary providers and long-term care facilities.

Simpra Advantage’s product offerings will focus on historically underserved individuals in Alabama who struggle to navigate the health care system and are less likely to get health care when they need it. The product offerings will utilize an interdisciplinary care team model which will focus on the goals of the individual member. Each enrolled member will have a personalized plan of care and coordination of medical services and social services. It is the goal of Simpra Advantage to develop a health care delivery system that can produce measurable improvement in the health status of enrolled members, while maintaining reasonable financial stability.

Want more information about Simpra Advantage?

Call us at 1-844-637-4770 (TTY 711). Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact me form to have us call you.

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