Simpra Advantage Nursing Home Plan (PPO I-SNP)
Alabama Institutional Special Needs I-SNP Plan (2025 Plan)
Additional Coverage
HearingVision
Overall Government Star Rating
(coming soon)
Plan Name
Simpra Advantage Nursing Home Plan (PPO I-SNP)
Plan Type
Institutional Special Needs Plan (I-SNP)
Simpra Advantage Nursing Home Plan (PPO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in Alabama and offered by the health insurance company Simpra Advantage. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Annual Deductible
Coming soon
Primary doctor visit
20% coinsurance per visit
Specialist visit
20% coinsurance per visit
ER visit
20% coinsurance per visit (always covered)
Ambulance
20% coinsurance
Simpra Advantage Nursing Home Plan (PPO I-SNP) has a monthly premium cost of $40 per month, with an annual deductible of Coming soon and a maximum out of pocket cost sharing of $14,000 In and Out-of-network
$8,975 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Simpra Advantage Nursing Home Plan (PPO I-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Simpra Advantage Nursing Home Plan (PPO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Simpra Advantage Nursing Home Plan (PPO I-SNP) includes coverage for hearing, vision.
Medicare Advantage health plans can offer even more additional benefits. Simpra Advantage Nursing Home Plan (PPO I-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$14,000 In and Out-of-network
$8,975 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
20% coinsurance per visit (always covered)
Urgent care
20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: Coming soon
Out-of-network: Coming soon
Outpatient hospital coverage
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: Coming soon
Out-of-network: Coming soon
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
| Generic |
| Preferred Brand |
| Non-Preferred Drug |
| Specialty Tier |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Hearing
Hearing exam
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
Comprehensive dental
Prosthodontics, removable
Maxillofacial prosthetics
Oral and maxillofacial surgery
Adjunctive general services
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
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