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Simply Level (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level (HMO C-SNP) in 2026, please refer to our full plan details page.
Simply Level (HMO C-SNP) is a HMO C-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 Level (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level (HMO C-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 Level (HMO C-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 Level (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $42.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3450.00 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 Level (HMO C-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. You will enjoy no copay for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 6 supplemental drugs. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at preferred pharmacies, standard pharmacies, and standard mail order. For Tier 4 non-preferred drugs, a one-month supply costs a $25 copay at preferred pharmacies and standard mail order, or a $30 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. Outpatient services and diagnostic tests are highly affordable, ranging from no copay up to a $50 copay with no coinsurance. Emergency care is available with a $140 copay, which is waived if you are admitted, while urgently needed services require no copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing services with no copay or coinsurance up to specified annual limits. Skilled nursing facility care starts with no copay for the first 20 days, and durable medical equipment is covered with no copay and a coinsurance of 0% to 20%. Additionally, members receive a $45 monthly over-the-counter allowance and chronic illness meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Simply Level (HMO C-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, although prior authorization and referrals are required. While up to 3 additional acute care days are covered at no cost, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Simply Level (HMO C-SNP) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a $0 to $50 copay, while observation services and outpatient substance abuse sessions require a $50 copay.
Partial Hospitalization See details
Simply Level (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Level (HMO C-SNP), featuring a $75 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation services are partially covered with no copay or coinsurance for plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Simply Level (HMO C-SNP) covers emergency services with a $140 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with a $140 copay and no coinsurance.
Primary Care See details
Simply Level (HMO C-SNP) covers primary care, specialist, therapy, mental health, podiatry, and telehealth services with no copay and no coinsurance, though chiropractic services are not covered. Opioid treatment program services are covered with a $50 copay and no coinsurance.
Preventive Services See details
Simply Level (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Simply Level (HMO C-SNP) with no copay or coinsurance for Medicare-covered exams, routine annual exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 yearly maximum, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Simply Level (HMO C-SNP), featuring routine eye exams and eyewear with no copay, no coinsurance, and no deductible. This benefit includes a $350 combined annual limit for eyewear like contact lenses and eyeglasses, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Level (HMO C-SNP) with no copay and no coinsurance for diagnostic, preventive, and comprehensive care, up to a $1,200 annual maximum. While oral exams, cleanings, and restorative services are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Level (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Simply Level (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level (HMO C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, while prosthetics and medical supplies are covered with no copay and 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes, is covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Level (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services or outpatient x-rays, while diagnostic procedures and tests range from no copay up to a $50 copay.
Home Health Services See details
Simply Level (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Simply Level (HMO C-SNP) with no copay and no coinsurance, requiring both prior authorization and a referral. While some services are covered, specific programs including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Simply Level (HMO C-SNP) with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under Simply Level (HMO C-SNP) are partially covered, offering a $45 monthly over-the-counter allowance and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone, and certain other services are not covered under this benefit.
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* 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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