PROVIDER UPDATE: In response to the temporary CHC service interruption, Simpra has contracted with Availity for claims submission. Continue to use codes SIM-01 and SIM-02. Contact your clearinghouse to determine if previously submitted claims need to be resubmitted.

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 is health coverage provided by the federal government. Coverage is limited to care from providers such as hospitals, skilled nursing facilities, hospice services, or home health care.

4. Q: Why should someone enroll in a Simpra Advantage?

A: Simpra Advantage Members receive more benefits than those covered only by Original Medicare. Each Member receives personalized care coordinated by their Advanced Practice Provider and an assigned care team.

Contact a Simpra Advantage Representative or our Call Center at 1-844-637-4770 (TTY/TDD 1-833-312-0044) 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.

  1. Simpra Advantage PPO I-SNP is designed for people who live in a Skilled Nursing Facility.
  2. Simpra Advantage Premier PPO I-SNP is designed for people living in an Assisted Living Facility.
  3.  Simpra Advantage PPO D-SNP is available for individuals in the community who have Medicare and Medicaid coverage.
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 1-844-637-4770 (TTY/TDD 1-833-312-0044) to speak to a Simpra Advantage Representative.

9. Q: How do I enroll in Simpra Advantage?

A: There are three different ways to enroll in a Simpra Advantage.

  • Call the Simpra Call Center at 1-844-637-4770 (TTY/TDD 1-833-312-0044);
  • If you live in a Nursing Home or Assisted Living Facility, contact your admissions team to request a meeting with a Simpra Advantage Representative; or
  • Complete and mail in the 2024 Enrollment Form. Instructions for mailing are 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 any responsible party’s contact information.

11. Q: Where can I get a complete list of in-network providers for Simpra Advantage?
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. Simpra Advantage provides you the same benefits for in-network and out-of-network providers.

13. Q: Who can I call with questions about Simpra Advantage?

A: If you do not already have a representative, contact Member Services at 1-844-637-4770 (TTY/TDD 1-833-312-0044).

14. Q: I have Original Medicare and a Medicare Supplement plan. Can I enroll in Simpra Advantage?

A: Yes! Contact Member Services at 1-844-637-4770 (TTY/TDD 1-833-312-0044) 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. Contact a Simpra Advantage Representative or Member Services at 1-844-637-4770 (TTY/TDD 1-833-312-0044) for assistance.

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.