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Simpra Advantage Assist (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simpra Advantage Assist (PPO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simpra Advantage Assist (PPO I-SNP) in 2026, please refer to our full plan details page.
Simpra Advantage Assist (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 Assist (PPO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simpra Advantage Assist (PPO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simpra Advantage Assist (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.
For Simpra Advantage Assist (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $81.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Simpra Advantage Assist (PPO I-SNP) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $150.00. The standard Part D premium is $71.00, though this may be reduced to $43.30 for those qualifying for the low-income subsidy. During the initial coverage phase, standard pharmacy and standard mail orders for a 30-day supply require a $15.00 copay for preferred generics, a $45.00 copay for standard generics, a $95.00 copay for preferred brands, and a 31% coinsurance for non-preferred drugs. This cost-sharing structure remains in place until your total drug costs reach $2,100.00. Once your yearly out-of-pocket costs hit the $2,100.00 threshold, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Simpra Advantage Assist (PPO I-SNP) offers structured coverage for essential medical services, focusing on predictable copays and coinsurance. Inpatient hospital stays require a $175 daily copay for the first six days, followed by no copay for days 7 through 90, while emergency care carries a $90 copay. For routine healthcare, specialist visits require a $30 copay, whereas Medicare-covered preventive services are available with no copay or coinsurance. This plan also features valuable supplemental benefits, including a $230 annual eyewear allowance and a $2,000 hearing aid benefit every two years, both with no copay or coinsurance. Dental care is covered with a 20% coinsurance up to a $750 annual limit, while durable medical equipment also requires a 20% coinsurance with no copay. Additionally, members receive a $235 quarterly allowance with no copay for over-the-counter items.
Inpatient Hospital See details
Simpra Advantage Assist (PPO I-SNP) partially covers inpatient acute and psychiatric hospital stays with a $175 daily copay for days 1 to 6, no copay for days 7 to 90, and no coinsurance. Specific sub-services including additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simpra Advantage Assist (PPO I-SNP) covers outpatient services with copays ranging from $30 to $50 for outpatient hospital care, $30 for substance abuse sessions, $50 for ambulatory surgical center services, and $100 per stay for observation services, with no coinsurance. Outpatient blood services are covered with a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Simpra Advantage Assist (PPO I-SNP) with a $30.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Simpra Advantage Assist (PPO I-SNP) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $150 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Emergency services are partially covered by Simpra Advantage Assist (PPO I-SNP), with a $90 copay and no coinsurance for emergency care, and a $30 copay and no coinsurance for urgently needed services. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Simpra Advantage Assist (PPO I-SNP) covers primary care, therapy, and specialist visits, with a $30 copay for specialist, mental health, and psychiatric services. Chiropractic services are partially covered, excluding routine care, while routine podiatry is covered for up to six visits yearly with a 20% coinsurance, and telehealth benefits range from no copay to a $30 copay with 20% coinsurance.
Preventive Services See details
Simpra Advantage Assist (PPO I-SNP) partially covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and glaucoma screenings. However, the annual physical exam is not covered, and while some additional preventive services are covered, none are provided in practice, including fitness benefits, health education, and in-home support.
Hearing Services See details
Hearing services are partially covered by Simpra Advantage Assist (PPO I-SNP), featuring hearing exams with a $10 copay and no coinsurance, though routine exams have no copay and fitting evaluations are not covered. Prescription hearing aids are also partially covered with no copay or coinsurance up to a $2,000 maximum benefit every two years, while inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Simpra Advantage Assist (PPO I-SNP) covers annual routine eye exams with a $30 copay and no coinsurance. Additionally, the plan offers up to $230 in annual coverage for eyewear, including contacts and eyeglasses, with no copay or coinsurance.
Dental Services See details
Simpra Advantage Assist (PPO I-SNP) partially covers dental services, offering Medicare-covered dental care with a 20% coinsurance and no copay alongside a $750 annual maximum for other covered services. However, fluoride treatment, adjunctive general services, periodontics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Simpra Advantage Assist (PPO I-SNP) covers Home Infusion bundled Services with prior authorization, including Medicare Part B insulin which requires a $35 copay and no coinsurance to 20% coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Simpra Advantage Assist (PPO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Simpra Advantage Assist (PPO I-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetic devices.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Simpra Advantage Assist (PPO I-SNP) with prior authorization required, as lab services are not covered. Diagnostic procedures and tests require a 20% coinsurance and no copay, while covered radiological services require no coinsurance and carry copays of $50 for diagnostic and therapeutic radiology and $5 for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Simpra Advantage Assist (PPO I-SNP), though prior authorization is required to receive care. Specific copayment and coinsurance cost-sharing details are not specified for this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), are not covered by the Simpra Advantage Assist (PPO I-SNP) plan.
Skilled Nursing Facility (SNF) See details
Simpra Advantage Assist (PPO I-SNP) partially covers Skilled Nursing Facility (SNF) services, which require prior authorization and do not require a prior three-day inpatient hospital stay. While specific copay and coinsurance amounts are not provided, cost-sharing does apply (including on the day of discharge), and additional days beyond Medicare-covered SNF care are not covered.
Other Services See details
Simpra Advantage Assist (PPO I-SNP) partially covers Other Services, providing a maximum allowance of $235 every three months with no copay or coinsurance for Over-the-Counter (OTC) items via reimbursement. Acupuncture, Meal Benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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