Simpra Advantage Nursing Home Plan (PPO I-SNP) H4091-001 • 2027 • Calhoun County, AL
- Monthly Premium
- $13.70Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Calhoun County, AL
- Local Enrollment
- 68 beneficiaries in Calhoun County
Introduction
CMS Plan ID H4091-001 identifies Simpra Advantage Nursing Home Plan, 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 $13.70 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment in this plan requires you to live in Calhoun County, Alabama. CMS reports 68 beneficiaries enrolled in this plan in Calhoun County. New members can call the plan directly at (844)637-4770 (TTY (833)312-0044) for assistance.
Eligibility
Simpra Advantage Nursing Home Plan is a Facility-based Institutional (FI-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 is for individuals living in a long-term care 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 Calhoun County
Compare this plan with the two most-enrolled PPO I-SNP plans available in Calhoun County, Alabama. Enrollment is based on CMS local enrollment data.
| Plan Detail | Simpra Advantage Nursing Home Plan | UHC Nursing Home Plan EX-F001 | Simpra Advantage Assist |
|---|---|---|---|
| CMS Plan ID | H4091-001-0 |
H0710-004-0 |
H4091-003-0 |
| Local Enrollment | 68 | 50 | 0 |
| Monthly Premium | $13.70 | $0.00 | $90.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,850.00 | $9,850.00 | $6,700.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | 20% coinsurance | 0%-20% coinsurance | $0 copay |
| Specialist | 20% coinsurance | 0%-20% coinsurance | $30 copay |
| Part D Deductible | $700.00 | $700.00 | $150.00 |
| CMS Star Rating | Not yet rated | 5.0 | Not yet rated |
| Dental | Not covered | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Special Needs plans in Calhoun County, or compare Medicare Advantage SNP plans across Alabama, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Simpra Advantage Nursing Home Plan 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 H4091-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4091-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Specialist
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: 0%-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: 20% coinsurance
Out-of-network: 20% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Outpatient x-rays
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Diagnostic tests and procedures
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- 20% coinsurance
- Worldwide emergency care
- Coming soon
- Urgent care
- 20% coinsurance
- Inpatient hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150 - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$217 per day for days 21-100
Out-of-network: - Ground ambulance
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Outpatient group therapy
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Occupational therapy
- In-network: 20% coinsurance
Out-of-network: 20% 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
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
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
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - 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 Nursing Home Plan as a Part B benefit.
Prescription Drug Coverage
Simpra Advantage Nursing Home Plan 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $13.70 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $13.70 |
| Low-Income Premium Subsidy: | $13.65 |
| Low-Income Premium Subsidy Paid by CMS: | $13.70 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 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 Nursing Home Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4091)
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
| 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
| 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.
| 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 | Compare types of Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.