Simpra Advantage Assist (PPO I-SNP)
Alabama Institutional Special Needs I-SNP Plan (2025 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
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Plan Name
Simpra Advantage Assist (PPO I-SNP)
Plan Type
Institutional Special Needs Plan (I-SNP)
Simpra Advantage Assist (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.
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$90 copay per visit (always covered)
Simpra Advantage Assist (PPO I-SNP) has a monthly premium cost of $86 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $10,000 In and Out-of-network
$6,700 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 Assist (PPO I-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Simpra Advantage Assist (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 Assist (PPO I-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Simpra Advantage Assist (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
$10,000 In and Out-of-network
$6,700 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $30 copay per visit
Out-of-network: $30 copay 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: $0 copay
Diagnostic radiology services (like MRI)
In-network: $50 copay
Out-of-network: $50 copay
Outpatient x-rays
In-network: $5 copay
Out-of-network: $5 copay
Emergency care
$90 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $175 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: $175 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
In-network: $30-50 copay per visit
Out-of-network: $50 copay per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 copay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $150 copay
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient group therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy visit
In-network: $30 copay
Out-of-network: $30 copay
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 | $4.00 copay | $0 copay |
| Generic | $15.00 copay | $0 copay |
| Preferred Brand | $45.00 copay | $0 copay |
| Non-Preferred Drug | | |
| Specialty Tier | 31% coinsurance | $0 copay |
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: $10 copay
Out-of-network: $10 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
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
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
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