Simpra Advantage Nursing Home Plan (PPO I-SNP) H4091-001

Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) is an Institutional Special Needs Plan, a Medicare Advantage plan for people whose qualifying institutional level of care the plan verifies. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 1 formulary tiers. Published supplemental benefits include vision ($230/yr eyewear allowance), hearing ($2,000 hearing aid allowance per 2 years), over-the-counter (OTC) ($300/quarter OTC allowance), and transportation (12 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

The published 2026 monthly plan premium for Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) is $27.70. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $615. The in-network medical out-of-pocket maximum is $8,600; it does not include Part D drug spending. Published visit costs include primary care 20% and specialist visits 20%. These figures are plan data, not a personal yearly-cost estimate.

CMS lists Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) as a Local PPO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) is listed in the current plan record as a I-SNP. The plan must verify that, for 90 days or longer, you have needed or are expected to need the level of care provided in a qualifying institution. Some plans also serve people who need an equivalent institutional level of care while living in the community. Review the official plan documents for the residence, care-level, and enrollment requirements.

Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) is identified in the current plan record as an Institutional Special Needs Plan. The record identifies Part D prescription drug coverage. It also lists vision ($230/yr eyewear allowance), hearing ($2,000 hearing aid allowance per 2 years), over-the-counter (OTC) ($300/quarter OTC allowance), transportation (12 one-way trips/year), and meals (Meal benefit). The page data does not describe facility-specific therapy, nursing, or care-coordination arrangements. Confirm covered services, participating facilities, benefit limits, and coordination responsibilities in the official plan documents before enrolling.

Simpra Advantage Nursing Home Plan (PPO I-SNP) (Local PPO) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a I-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.