Medicare Plans

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Simpra Advantage Assist (PPO I-SNP) H4091-003 • 2027 • Barbour County, AL

CMS Rating: Not yet rated by CMS.
Monthly Premium
$90.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6700.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $150.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Barbour County, AL
Local Enrollment
0 beneficiaries in Barbour County
Last update:

Introduction

CMS Plan ID H4091-003 identifies Simpra Advantage Assist, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Simpra Advantage. Its provider network is a Preferred Provider Organization (PPO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $90.00 monthly premium, $0.00 medical deductible, and $6700.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $150.00.

Enrollment in this plan requires you to live in Barbour County, Alabama. CMS reports 0 beneficiaries enrolled in this plan in Barbour County. New members can call the plan directly at (844)637-4770 (TTY (833)312-0044) for assistance.

Eligibility

Simpra Advantage Assist is a Hybrid Institutional (HI-SNP) plan for individuals that require nursing care.

Special Needs Plan Type
Institutional Special Needs Plan (I-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan accommodates individuals in a long-term care facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Barbour County

Compare this plan with the most-enrolled other PPO I-SNP plan available in Barbour County, Alabama. Enrollment is based on CMS local enrollment data.

PPO I-SNP plan comparison for Barbour County, Alabama
Plan Detail Simpra Advantage Assist Simpra Advantage Nursing Home Plan
CMS Plan ID H4091-003-0 H4091-001-0
Local Enrollment 0 34
Monthly Premium $90.00 $13.70
Medical Deductible Coming soon Coming soon
Maximum Out-of-Pocket $6,700.00 $9,850.00
Part B Giveback Coming soon Coming soon
Primary Care Coming soon Coming soon
Specialist Coming soon Coming soon
Part D Deductible $150.00 $700.00
CMS Star Rating Not yet rated Not yet rated
Dental Coming soon Coming soon
Vision Coming soon Coming soon
Hearing Coming soon Coming soon

Looking for additional options? Explore other plans available in Barbour County, or visit our Alabama Medicare Special Needs plan directory for statewide comparisons of premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

Simpra Advantage Assist has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4091-003.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4091-003-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Specialist
In-network: $30 copay
Out-of-network: $30 copay

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
In-network: $0-$30 copay, 20% coinsurance
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $50 copay
Out-of-network: $50 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Outpatient x-rays
In-network: $5 copay
Out-of-network: $5 copay
Diagnostic tests and procedures
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Emergency and Urgent Care Services

Emergency room care
$90 copay
Worldwide emergency care
Coming soon
Urgent care
$30 copay
Inpatient hospital care
In-network:
Tier 1
$175 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$175 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Skilled Nursing Facility
In-network:
$0 copay
Ground ambulance
In-network: $150 copay
Out-of-network: 20% coinsurance

Mental Health Services

Outpatient individual therapy
In-network: $30 copay
Out-of-network: $30 copay
Outpatient group therapy
In-network: $30 copay
Out-of-network: $30 copay
Inpatient psychiatric hospital care
In-network:
Tier 1
$175 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$175 per day for days 1-6
$0 per day for days 7-90
$0 per stay

Rehabilitation Services

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

Medical Equipment and Supplies

Diabetes supplies
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Periodontics
Not covered
Endodontics
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Restorative services
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Vision Services

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass frames only
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass lenses only
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Upgrades
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Hearing Services

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Fitting/evaluation
Not covered
Prescription hearing aids
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Simpra Advantage Assist as a Part B benefit.

Prescription Drug Coverage

Simpra Advantage Assist includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Simpra Advantage Assist (H4091-003-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($65.60)
Supplemental Part D Premium:$81.20
Total Part D Premium:$15.60
Low-Income Premium Subsidy:$13.65
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$15.60

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $150.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Simpra Advantage starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Simpra Advantage Assist may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Simpra Advantage Assist (H4091-003-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$4.00 copay
Generic$15.00 copay$15.00 copay
Preferred Brand$45.00 copay$45.00 copay
Non-Preferred Drug$95.00 copay$95.00 copay
Specialty Tier31% coinsurance31% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H4091)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H4091
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Not enough data available
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan Not enough data available
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service Not enough data available
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Simpra Advantage

Website
Simpra Advantage Plan Page
Providers
Simpra Advantage Providers Page
Formulary
Simpra Advantage Formulary Page
Pharmacy
Simpra Advantage Pharmacy Page
New Member Health Plan Help
(844)637-4770
New Member Health Plan TTY
(833)312-0044
New Member Part D Help
(844)637-4770
New Member Part D TTY Users
(833)312-0044

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Simpra Advantage (official source) http://www.simpra.com October 4, 2026
CMS.gov Institutional Special Needs Plans (I-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.