When You Need Extra Help

Some people with limited resources and income also may be able to get “Extra Help” to pay for the costs of a Medicare prescription drug plan, including monthly premiums, annual deductibles and prescription co-payments.

You automatically qualify and do not need to apply for Extra Help if you have Medicare and meet one of the following conditions

Have full Medicaid coverage
Have Supplemental Security Income (SSI)
Participate in a state program that pays your Medicare premiums

If you have questions about “Extra Help,” call

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week
The Social Security Office at 1-800-772-1213, between 8 am to 7 pm, Monday – Friday. TTY users should call 1-800-325-0778
Your state Medicaid Office

If you believe that your cost-sharing amount for any prescriptions is incorrect, Simpra Advantage Health Plans can help you

Request help to obtain evidence of your proper copay level, or
By submitting the existing evidence to Medicare on your behalf.
As a Part D plan sponsor, CMS regulations require us to have a process to help you determine if you are eligible for the Low Income Subsidy (LIS) when some of your documentation is missing or there is a conflict between the CMS system and your actual status.
Before you enroll, Simpra Adantage Plans will tell you what your plan premium will be with a low-income subsidy.

Simpra Advantage Health Plans accepts the following forms of evidence to establish the subsidy status of a beneficiary that is institutionalized and qualifies for zero cost-sharing

Documentation from the facility showing Medicaid payments for a full calendar month
Documentation from the state that confirms Medicaid payment to the facility for a full calendar month
A screen print from State Medicaid showing the institutional status based on a full calendar month stay for Medicaid payment purposes

Simpra Advantage Health Plans accepts the following forms of evidence to establish the subsidy status of a dual eligible individual

A copy of valid State Medicaid Card showing eligibility dates
Complete documentation of contact with State Medicaid verifying the Medicaid status (including date and time of contact, name, title, and phone number of the person contacted)
Documentation that confirms active Medicaid status
A printout from the State electronic enrollment file showing Medicaid status
A screen print from the State’s Medicaid systems showing Medicaid status
Other documentation provided by the State showing Medicaid status

These documents may be mailed to Simpra Advantage
Alabama's Health Plans’ main office

Simpra Advantage
PO BOX 23607
Tampa, FL 33623-3607

Still have questions?

Our team is standing by to help make your prescriptions payments easy.
CONTACT SUPPORT

Disclaimers

Page last updated: 11/01/2024 Nondiscrimination noticeThe company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律，並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。

Disclaimers

Page last updated: 11/01/2024
Nondiscrimination notice
Simpra Advantage is a PPO I-SNP and PPO D-SNP with a Medicare contract. Enrollment in Simpra Advantage plans depends on CMS Medicare contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system. Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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