Simpra Advantage Nursing Home Plan (PPO I-SNP)

Simpra Advantage Nursing Home Plan (PPO I-SNP) is a PPO I-SNP plan offered by Associated Care Ventures, Inc. available for enrollment in 2025 to people living in Alabama statewide. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Simpra Advantage Nursing Home Plan (PPO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Simpra Advantage Nursing Home Plan (PPO I-SNP).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Simpra Advantage Nursing Home Plan (PPO I-SNP) features a defined standard drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay cost-sharing amounts during the initial coverage phase until total drug costs reach $2,100.00. If you qualify for the low-income subsidy (LIS), your Part D premium may be reduced to $27.70. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. This ensures you pay nothing for covered medications for the rest of the calendar year. Prospective members should check the plan's formulary to confirm specific drug coverage and tier details.

Additional Benefits

The Simpra Advantage Nursing Home Plan (PPO I-SNP) offers comprehensive medical coverage featuring no copays and a standard 20% coinsurance for most outpatient, emergency, primary care, and specialist services. Inpatient hospital stays and skilled nursing facility care are covered utilizing Medicare-defined cost-sharing, while select preventive care and lab services are available with no copay or coinsurance. Additionally, essential services like dialysis, medical equipment, and ambulance transportation are covered with no copay and a 20% coinsurance. This plan also includes valuable supplemental benefits, such as a $300 quarterly over-the-counter allowance with no copay or coinsurance. Routine vision and hearing exams are covered with no copay and up to 20% coinsurance, alongside allowances of $230 annually for eyewear and up to $2,000 every two years for hearing aids. Members also benefit from Medicare-covered dental services and up to 12 one-way transportation trips per year to plan-approved locations.