Disclaimers
Simpra Advantage Information:
Simpra Advantage is a PPO I-SNP and PPO D-SNP with a Medicare contract. Enrollment in Simpra Advantage plans depends on contract renewal. MA organizations are evaluated yearly by Medicare and ratings are based on a 5-star rating system. Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Based on a Model of Care review, Simpra Advantage has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (SNP) through 2029. We do not offer every plan available in your area. Currently, our contracted sales agents represent eight organizations which offer 104 products in your area. Please contact Medicare.gov or 1-800-MEDICARE (24/7) to get information on all of your options.
For accommodations for persons with special needs, call Member Services at 1-844-637-4770 (TTY/TDD 1-833-312-0044) 8 a.m. – 8 p.m. local time, 7 days a week from 10/1 to 3/31, and Monday to Friday from 4/1 to 9/30. Member Services is closed Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving, and Christmas.
2026 Special Supplemental Benefits for the Chronically Ill (SSBCI) Information:
2026 Simpra Advantage Nursing Home Plan (PPO I-SNP): Social Companion Support is a Special Supplemental Benefit for the Chronically Ill (SSBCI). To be eligible for Social Companion Support, you must have one or more of the following chronic conditions: Dementia or Chronic and disabling mental health conditions. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
2026 Simpra Advantage Dual Care (PPO D-SNP): Food and Produce, General Supports for Living, and Social Needs benefits are Special Supplemental Benefits for the Chronically Ill (SSBCI). To be eligible for these benefits, you must have one or more of the following chronic conditions: Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic alcohol use disorder and other substance use disorders (SUDs); Chronic and disabling mental health conditions; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Chronic gastrointestinal disease; Chronic heart failure; Chronic kidney disease (CKD); Chronic lung disorders; Conditions associated with cognitive impairment; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Conditions with functional challenges; Dementia; Diabetes mellitus; HIV/AIDS; Immunodeficiency and Immunosuppressive disorders; Neurologic disorders; Overweight, obesity and metabolic syndrome; Post-organ transplantation; Severe hematologic disorders; or Stroke. These conditions may not apply to all types of SSBCI benefits. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
2026 Simpra Advantage Assist (PPO I-SNP): Social Companion Support and Food and Produce are Special Supplemental Benefits for the Chronically Ill (SSBCI). To be eligible for SSBCI benefits, you must have one or more of the following chronic conditions: Cardiovascular disorders; Chronic heart failure; Chronic and disabling mental health conditions; Chronic malnutrition including failure to thrive; Dementia; Diabetes mellitus; Chronic lung disorders; or Stroke. These conditions may not apply to all types of SSBCI benefits. Not all enrollees qualify. If you qualify for one of the conditions, you must also qualify as a “chronically ill” enrollee as defined by CMS regulations and on this Plan’s coverage criteria for SSBCI.
2027 Special Supplemental Benefits for the Chronically Ill (SSBCI) Information:
2027 Simpra Advantage Nursing Home Plan (PPO I-SNP): Special Supplemental Benefits for this plan include Over-the-Counter benefits (personal hygiene items, essential clothing, food and produce) and the Social Needs Benefit. To qualify for these benefits, you must have one or more of the following chronic conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning. Not all enrollees qualify. If you qualify for one of the conditions above, your coverage also depends on being a “chronically ill enrollee” as defined by CMS regulations and on this Plan’s coverage criteria.
2027 Simpra Advantage Dual Care (PPO D-SNP): Special Supplemental Benefits for this plan include Over-the-Counter benefits (rent, utilities, personal hygiene items, essential clothing, food and produce) and the Social Needs Benefit. To qualify for these benefits, you must have one or more of the following chronic conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning. Not all enrollees qualify. If you qualify for one of the conditions above, your coverage also depends on being a “chronically ill enrollee” as defined by CMS regulations and on this Plan’s coverage criteria.
2027 Simpra Advantage Assist (PPO I-SNP): Special Supplemental Benefits for this plan include Over-the-Counter benefits (personal hygiene items, essential clothing, food and produce) and the Social Needs Benefit. To qualify for these benefits, you must have one or more of the following chronic conditions: Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic lung disorders; Chronic and disabling mental health conditions; Stroke, or Chronic malnutrition including failure to thrive. Not all enrollees qualify. If you qualify for one of the conditions above, your coverage also depends on being a “chronically ill enrollee” as defined by CMS regulations and on this Plan’s coverage criteria.
Over-the-Counter Benefit Information:
The Benefits Mastercard® Prepaid Card is issued by The Bancorp Bank N.A., pursuant to license by Mastercard International Incorporated and card can be used for eligible expenses wherever Mastercard is accepted. Mastercard and the circles design is a trademark of Mastercard International Incorporated. Valid only in the U.S. No cash access. This is not a gift card or gift certificate. Prepaid cards are distributed as a gratuity without the payment of any monetary value or consideration. This card cannot be used to pay for prescription drugs or products that are not eligible. Product exclusions include alcohol, tobacco, firearms and gift cards. If you would like to buy items that are not eligible, you will need to use another form of payment. Only Nations Benefits® supports the Over-the-Counter (OTC) benefit.
Out-of-Network Provider Information:
Go to https://simpra.com/for-members/out-of-network-coverage-rules/ for information on Out-of-Network coverage. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number (Member Services), or see your Evidence of Coverage (https://simpra.com/for-members/plan-documents/) for more information, including the cost-sharing that applies to out-of-network services. Member Services is available at 1-844-637-4770 (TTY/TDD 1-833-312-0044) 8 a.m. – 8 p.m. local time, 7 days a week from 10/1 to 3/31, and Monday through Friday from 4/1 to 9/30 and closed Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving, and Christmas.
