A non-government entity
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 2025, 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 2025.
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 $590.00 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:
Sign up for Simply Complete (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply Complete (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after the deductible, you will pay 25% coinsurance for most drugs at standard pharmacies. For drugs in the specialty tier, you will have no copay. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, dental, home health, and medical equipment. The plan also covers ambulance and transportation services, emergency services, and various other services, such as home infusion, dialysis, and over-the-counter items. This plan provides additional benefits like hearing aids, eyewear, and specific preventive services with no copay. The plan also covers transportation, and has a maximum plan benefit for worldwide emergency services. The plan also provides meal benefits and covers a range of dental services, all with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Complete (HMO D-SNP) plan, with no copay required. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare plans, are covered. All Ambulance Services have no coinsurance and a copay for Medicare-covered ground and air ambulance services. Transportation Services have no copay, and the plan covers transportation to a plan-approved health-related location, including rideshares, buses, vans, and medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply Complete (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $0 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage amount of $100,000.
Primary Care See details
Primary Care services are covered, including Primary Care Physician Services, with no copay. Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are also covered, but may require prior authorization and/or a doctor referral.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar services with a required doctor referral, but annual physical exams are not covered. Additional preventive services include Health Education and Fitness Benefit with no copay, and Home and Bathroom Safety Devices and Modifications, with a maximum plan benefit coverage amount of $150. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Simply Complete (HMO D-SNP) covers hearing exams and fitting/evaluation for hearing aids with no copay, as well as routine hearing exams once per year with no copay. The plan offers up to $2,000 per year for prescription hearing aids with no copay, but does not cover inner ear, outer ear, or over-the-ear hearing aids. OTC hearing aids are covered up to $500 per year.
Vision Services See details
The Simply Complete (HMO D-SNP) plan covers vision services, including routine eye exams with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay; however, there is a combined maximum plan benefit of $400 per year.
Dental Services See details
The Simply Complete (HMO D-SNP) plan covers dental services with no copay for Medicare Dental Services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics. Oral exams, dental x-rays, prophylaxis (cleaning), endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery are limited in the number of visits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Complete (HMO D-SNP) plan, with a $0 copay for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Simply Complete (HMO D-SNP) plan with no copay. There is also no coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. DME and Prosthetic Devices have no copay and no coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Lab services, diagnostic radiological services, and outpatient X-ray services have no copay, while other services may have a copay.
Home Health Services See details
Home Health Services are covered by the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services", the Simply Complete (HMO D-SNP) plan covers over-the-counter items with no copay, and a monthly maximum of $103, but does not cover acupuncture, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. The plan also covers meal benefits with no copay, but requires prior authorization and a doctor referral.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved