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Simpra Advantage Dual Care (PPO D-SNP)

Health Insurance Company: Simpra Advantage

Medicare Advantage Plan Details

Medicare-Medicaid Dual Eligible (D-SNP)

Simpra Advantage
$0 /mo
monthly premium
Simpra Advantage Dual Care (PPO D-SNP)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
(coming soon)

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$9350
Rx Drug Coverage
Yes
Rx Deductible
$590
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
Yes
Fitness Benefits
Yes
Worldwide emergency
No
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist Office Visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay

Emergency Room

$0 copay

Ambulance Coverage

In-network: $0 copay
Out-of-network: 20% coinsurance

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0 copay
Out-of-network: 20% coinsurance
Medicare-covered lab services: In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0 copay
Out-of-network: 20% coinsurance
Medicare-covered x-ray services: In-network: $0 copay
Out-of-network: 20% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $0 copay
Out-of-network: Coming soon
Inpatient hospital psychiatric:
In-network: $0 copay
Out-of-network: Coming soon

Rehabilitation Coverage

Occupational therapy services:
In-network: $0 copay
Out-of-network: 20% coinsurance
Physical therapy and speech and language therapy services:
In-network: $0 copay
Out-of-network: 20% coinsurance

Urgent Care Coverage

$0 copay

Skilled Nursing Facility (SNF)

In-network: $0 copay
Out-of-network: Coming soon

Mental Health Coverage

Medicare-covered individual sessions: In-network: $0 copay
Out-of-network: 20% coinsurance
Medicare-covered group sessions: In-network: $0 copay
Out-of-network: 20% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays:
In-network: $0 copay
Out-of-network: 50% coinsurance

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $0 copay
Out-of-network: 20% coinsurance
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: $0 copay

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
No
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
No

Plan Links

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Where This Plan is Available

Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Simpra Advantage

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint