Frequently Asked Questions (FAQs)
1. Q: What is Simpra Advantage?
A: Simpra Advantage is a private insurance company offering Medicare Advantage PPO Special Needs Plans.
2. Q: What are Medicare Advantage PPO Special Needs Plans?
A: Medicare Advantage Special Needs Plans, sometimes referred to as SNPs, are a type of Medicare Advantage Plan offered by private insurance companies and approved by Medicare. SNPs have benefits designed for members with specific care needs. Benefits include all services covered by Original Medicare Parts A, B and D, plus they may offer additional supplemental benefits.
Simpra’s Special Needs Plans are also PPO plans. PPO stands for Preferred Provider Organization. Our plan offers benefits for both in-network and out-of-network providers. You can use any provider that accepts Medicare, and no referral is required by Simpra. Not all Medicare Advantage plans are PPO plans.
3. Q: What is Original Medicare?
A: Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare covers things like inpatient hospital care, doctors’ services and tests, and preventive services. (“What Original Medicare Covers”, December 2025, https://www.medicare.gov/providers-services/original-medicare)
4. Q: Why would someone enroll in a Simpra Advantage plan?
A: Simpra Advantage plans offer more benefits than Original Medicare alone. Each member receives personalized care coordinated by their Advanced Practice Provider and an assigned care team.
Call us at 1-833-4simpra to learn if you or a loved one is eligible to enroll.
5. Q: Who can enroll in Simpra’s Special Needs Plans?
A: Simpra offers three different Special Needs Plans to help meet your needs.
- Dual Care (PPO D-SNP) is available for individuals in the community who have Medicare and Medicaid coverage (QMB, QMB+, FBDE, SLMB+).
- Nursing Home Plan (PPO I-SNP) is designed for people who live in a Skilled Nursing Facility.
- Assist (PPO I-SNP) is designed for people living in an Assisted Living Facility.
6. Q: I have ESRD. Am I eligible to enroll in a Simpra Special Needs Plan?
A: Yes! Simpra Advantage plans cover Members with ESRD.
7. Q: Who can enroll a Member?
A: You can enroll yourself or an authorized representative such as a guardian or other legal representative may enroll you. A family member may help you to enroll.
8. Q: Who can help me enroll?
A: A family member or friend may help you enroll. A local Simpra Advantage Representative is also available to assist you. Call 1-833-4simpra to speak to a Simpra Advantage Representative.
9. Q: How do I enroll in a Simpra Advantage plan?
A: There are three different ways to enroll in a Simpra Advantage plan.
- Call 1-833-4simpra to speak to a Simpra Advantage representative to learn which Simpra Advantage plan may be right for you.
- Enroll online for 2026 plans.
- Print the 2026 Enrollment Form and mail it to Simpra Advantage at the address on the form.
10. Q: What information do I need to enroll?
A: Basic personal information is needed for enrollment, such as date of birth, social security number, Medicare and Medicaid numbers (as applicable), name of the primary care physician, and authorized representative contact information (if applicable).
11. Q: Where can I get a complete list of in-network providers for Simpra Advantage?
A: Visit our Provider and Pharmacy Directory.
12. Q: How do I keep my primary care physician if they are not in the Simpra Advantage network?
A: You can continue to see your primary care physician. Click here to learn about Out-of-Network coverage rules. You may also call 1-844-637-4770 (for assistance call TTY/TDD 1-833-312-0044) to speak to a Simpra Advantage Representative to request that your primary care physician be contacted to join the Simpra Advantage Network.
13. Q: Who can I call with questions about Simpra Advantage?
A: Call your Simpra Advantage representative or contact us at 1-833-4simpra.
14. Q: I have Original Medicare and a Medicare Supplement plan. Can I enroll in Simpra Advantage?
A: Yes! Contact us at 1-833-4simpra to speak with a Simpra Advantage Representative. We will work with you to find the Simpra Advantage Plan that best meets your needs.
15. Q: Can a person enrolled in another Medicare Advantage plan join a Simpra Advantage Plan?
A: Yes! They may change plans under certain circumstances. Call us at 1-833-4simpra to learn about your options.
16. Q: What happens to a person’s existing Medicare Advantage plan when they enroll in a Simpra Advantage Plan?
A: When a person enrolls in a Simpra Advantage Plan, they are automatically disenrolled from an existing Medicare Advantage plan.