Simpra Advantage (PPO SNP)

Medicare Advantage Plan for Alabama

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderSIMPRA Advantage
Plan IDH4091-2-0
CMS RatingNot Rated1
Plan TypePPO SNP
Annual Deductible$405.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$10,000 In and Out-of-network $6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$0 copay
Out-of-Network:
Coming soon
Outpatient hospital coverage
In-Network:
$0 copay
Out-of-Network:
20% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
20% per visit
Specialist:
In-Network:
$0 copay
Out-of-Network:
20% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent care
Emergency:
$0 copay
Urgent care:
$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0 copay
Out-of-Network:
20%
Lab services:
In-Network:
$0 copay
Out-of-Network:
20%
Diagnostic radiology services (e.g., MRI):
In-Network:
$0 copay
Out-of-Network:
20%
Outpatient x-rays:
In-Network:
$0 copay
Out-of-Network:
20%
Mental health services
In-Network:
$0 copay
Out-of-Network:
Coming soon
Outpatient group therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
20%
Outpatient group therapy visit:
In-Network:
$0 copay
Out-of-Network:
20%
Outpatient individual therapy visit:
In-Network:
$0 copay
Out-of-Network:
20%
Skilled Nursing Facility
In-Network:
$0 copay
Out-of-Network:
Coming soon
Rehabilitation services
Occupational therapy visit:
In-Network:
$0 copay
Out-of-Network:
20%
Physical therapy and speech and language therapy visit:
In-Network:
$0 copay
Out-of-Network:
20%
Ambulance
In-Network:
$0 copay
Out-of-Network:
20%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$0 copay
Out-of-Network:
20%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
$0 copay
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
$0 copay
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
20% per item
Wellness programs (e.g., fitness, nursing hotline)
Not covered
Medicare Part B drugs
Chemotherapy:
In-Network:
$0 copay
Out-of-Network:
20%
Other Part B drugs:
In-Network:
$0 copay
Out-of-Network:
20%

Coverage Area for Simpra Advantage (PPO SNP)

StateAlabama
CountyJefferson

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds15% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered15% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

Physician Finder

Physicians that accept Simpra Advantage (PPO SNP) for Alabama

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