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Simply Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Complete (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Complete (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Complete (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply Complete (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Simply Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Simply Complete (HMO D-SNP) Medicare prescription drug plan features an annual drug deductible of $615. Beneficiaries will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% coinsurance rate applies to standard retail pharmacy and standard mail-order fills during the initial coverage phase.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays, no coinsurance, and no deductibles for covered services. This includes complete coverage for inpatient and outpatient hospital stays, primary and specialist care, emergency services, and urgent care. Additionally, essential services like ambulance transport, medical equipment, and diagnostic testing are fully covered with no out-of-pocket costs. Members also benefit from valuable extra perks, including dental care up to $1,500 annually, vision exams with a $400 eyewear allowance, and hearing aids up to a $2,000 limit, all with no copay. The plan also features unlimited transportation to approved locations, a home meal benefit, and an $80 monthly over-the-counter allowance. Please note that many services, including comprehensive dental and home health care, require prior authorization or referrals.
Inpatient Hospital See details
Simply Complete (HMO D-SNP) partially covers inpatient hospital services, offering both acute and psychiatric care with no copay and no coinsurance. Prior authorization and referrals are required, and the plan does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Simply Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these outpatient benefits.
Partial Hospitalization See details
Simply Complete (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Simply Complete (HMO D-SNP) covers ground and air ambulance services with no copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for unlimited one-way trips to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Simply Complete (HMO D-SNP) offers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a maximum benefit limit of $100,000.
Primary Care See details
Simply Complete (HMO D-SNP) covers primary care, specialist visits, therapy, mental health, and telehealth services with no copay and no coinsurance. Routine podiatry is covered for up to 12 visits per year with no copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Simply Complete (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for covered benefits, which include kidney disease education, glaucoma screenings, and select home safety modifications. However, several sub-services are not covered, including annual physical exams, in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by Simply Complete (HMO D-SNP), offering Medicare-covered exams, one routine exam, and one fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually up to a $2,000 maximum with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Simply Complete (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits, including one routine eye exam and eyewear up to a $400 annual limit. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for preventive and comprehensive care up to a $1,500 yearly maximum. While most services are covered, prior authorization is required for comprehensive care, and implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Complete (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, which includes Medicare Part B insulin, chemotherapy, and other Part B drugs. Prior authorization and step therapy are required for these services.
Dialysis Services See details
Dialysis Services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
Simply Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and no coinsurance. Prior authorization is required for these benefits, and coverage may be limited to specified manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, though prior authorization and referrals are required. Covered services include lab tests, diagnostic procedures, therapeutic radiology, and X-rays.
Home Health Services See details
Home health services are covered under Simply Complete (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Simply Complete (HMO D-SNP) indicates some services are covered for cardiac rehabilitation with no copay and no coinsurance, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization and a referral are required for these services.
Skilled Nursing Facility (SNF) See details
Simply Complete (HMO D-SNP) covers Medicare-approved Skilled Nursing Facility (SNF) services for up to 100 days with no copay and no coinsurance, requiring both prior authorization and a referral. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Complete (HMO D-SNP) partially covers other services, offering a meal benefit and an $80 monthly over-the-counter allowance with no copay and no coinsurance. Acupuncture is not covered under this benefit, and the meal benefit requires prior authorization and a referral.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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