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Verified against CMS.gov · on Oct 1, 2026 Plan ID: H4091-001 Cross-check on Medicare.gov →

Simpra Advantage Nursing Home Plan (PPO I-SNP)

Plan Year 2026
$27.70 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
973 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 1 $0.00 Details
2 Venclexta Venetoclax Brand Tier 1 $0.00 Details
3 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
4 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 1 $0.00 Details
5 JAYPIRCA pirtobrutinib Brand Tier 1 $0.00 Details
6 Amoxicillin Brand Tier 1 $0.00 Details
7 Propranolol Hydrochloride propranolol hydrochloride Brand Tier 1 $0.00 Details
8 Digoxin Brand Tier 1 $0.00 Details
9 HYDROCODONE BITARTRATE AND ACETAMINOPHEN Brand Tier 1 $0.00 Details
10 Xalkori CRIZOTINIB Brand Tier 1 $0.00 Details
11 Fluphenazine Hydrochloride Brand Tier 1 $0.00 Details
12 Warfarin Sodium Brand Tier 1 $0.00 Details
13 Tacrolimus Brand Tier 1 $0.00 Details
14 Amoxicillin Brand Tier 1 $0.00 Details
15 Vigabatrin Brand Tier 1 $0.00 Details
16 Mefloquine Hydrochloride Brand Tier 1 $0.00 Details
17 Buspirone Hydrochloride Brand Tier 1 $0.00 Details
18 ELIQUIS apixaban Brand Tier 1 $0.00 Details
19 Nortriptyline Hydrochloride Brand Tier 1 $0.00 Details
20 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details

Showing 20 of 973 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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