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Simply Comfort (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Comfort (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Comfort (HMO I-SNP) in 2025, please refer to our full plan details page.
Simply Comfort (HMO I-SNP) is a HMO I-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in Florida. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Simply Comfort (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Comfort (HMO I-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 Comfort (HMO I-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 Comfort (HMO I-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 $3400.00 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 Comfort (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay varying costs depending on the drug tier and pharmacy. For instance, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy. For other tiers, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Simply Comfort (HMO I-SNP) plan offers comprehensive coverage with a focus on outpatient and primary care services. Many services have no copay, including inpatient hospital stays, outpatient services like observation and blood services, and primary care physician visits. The plan also provides coverage for transportation, vision, and dental services, often with no copay, and includes benefits like home health services and medical equipment. Additional benefits include hearing services, with hearing exams and hearing aids covered, and dental services, including oral exams and cleaning, with no copay. Emergency services and outpatient services have copays, such as $90 for emergency services, and up to $50 for outpatient hospital services. The plan also covers home infusion bundled services, with a $35 copay for Medicare Part B Insulin Drugs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has no copay for a Medicare-covered stay, and covers 3 additional days per benefit period. Inpatient Hospital Psychiatric has no copay for a Medicare-covered stay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $50, while Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay; Outpatient Substance Abuse Services have a $50 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Comfort (HMO I-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 are covered by the Simply Comfort (HMO I-SNP) plan. Ground ambulance services have a $180 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, offering up to 24 one-way trips per year via rideshare, bus/subway, van, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Simply Comfort (HMO I-SNP) plan. Emergency Services has a $90 copay with no coinsurance, and Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Simply Comfort (HMO I-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and physical therapy and speech-language pathology services all have no copay. Opioid treatment program services have a $50 copay.
Preventive Services See details
Preventive Services are covered by the Simply Comfort (HMO I-SNP) plan, with no copay for many services. The plan does not cover annual physical exams.
Hearing Services See details
Hearing Services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids, each with no copay for one visit per year. Prescription Hearing Aids (all types) are covered with no copay for two visits per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are also not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, including routine eye exams once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, have no copay, with a combined maximum benefit of $300 per year, and upgrades are not covered.
Dental Services See details
Simply Comfort (HMO I-SNP) covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery with no copay; however, fluoride treatment, implant services, and orthodontics are not covered. Oral exams are limited to 2 visits per year, dental x-rays are limited to 3, prophylaxis (cleaning) is limited to 2 visits per year, endodontics is limited to 1 visit per year, periodontics is limited to 1 scaling/root planing per quadrant every three years, prosthodontics (removable) is limited to 1 set of complete or partial dentures every five years and 1 denture adjustment reline per year, prosthodontics (fixed) is limited to 2 fixed partial dentures (bridges) every 5 years, and oral and maxillofacial surgery is limited to 6 extractions per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Comfort (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits under Simply Comfort (HMO I-SNP) include Durable Medical Equipment (DME) with a 0% to 20% coinsurance and Prosthetics/Medical Supplies with no coinsurance, and a copay for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Equipment is covered with a copay for Medicare-covered Diabetes Supplies and Diabetic Therapeutic Shoes or Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, Diagnostic Radiological Services and Therapeutic Radiological Services with a copay up to $50, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Simply Comfort (HMO I-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 not in practice. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the copay information is not provided. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The Simply Comfort (HMO I-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs, 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 are not covered.
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