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Simply More (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply More (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply More (HMO) in 2025, please refer to our full plan details page.
Simply More (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Polk. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Simply More (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply More (HMO).
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 More (HMO), 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 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 More (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay, while preferred brand drugs have a $55 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for your prescriptions.
Additional Benefits
The Simply More (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. The plan provides coverage for ambulance services with a copay or coinsurance, and emergency services have a copay. Primary care, preventive, hearing, vision, and dental services are covered, many with no copay. The plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. Additionally, the plan offers a Skilled Nursing Facility (SNF) benefit, as well as over-the-counter items and a meal benefit with no copays.
Inpatient Hospital See details
The Simply More (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 5 days of an Inpatient Hospital-Acute stay, there is a $40 copay per day, and then no copay for days 6-90; for days 1-5 of an Inpatient Hospital Psychiatric stay, there is also a $40 copay per day, and then no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but upgrades and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Simply More (HMO) plan, including all outpatient hospital services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $100, while observation services and ambulatory surgical center services have no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $50, and outpatient blood services have no copay.
Partial Hospitalization See details
Simply More (HMO) covers partial hospitalization with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Simply More (HMO). Ground ambulance services have a $200 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year using rideshare services, bus/subway, van, or medical transport. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Simply More (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay and no coinsurance. Urgently Needed Services has no copay and no coinsurance.
Primary Care See details
The Simply More (HMO) 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. You will pay no copay for primary care physician services, physician specialist services, and additional telehealth benefits. You will pay a $15 copay for occupational therapy services and physical therapy and speech-language pathology services. You will pay a $20 copay for individual and group sessions for mental health and psychiatric specialty services. You will pay a $50 copay for opioid treatment program services.
Preventive Services See details
The Simply More (HMO) plan covers preventive services, including Medicare-covered services with no copay and some additional preventive services. Some services, like an annual physical exam, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Other covered services, such as health education, personal emergency response systems, remote access technologies, fitness benefit, and kidney disease education, have no copay. Several other preventive services, like 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
The Simply More (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2,000 per year, and OTC hearing aids are covered up to $500 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered under the Simply More (HMO) plan, including eye exams and eyewear. Eye exams and eyewear have no copay, and contact lenses are unlimited, while eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are limited to one per year, and upgrades are covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with no copay, Oral Exams with no copay, Dental X-Rays with no copay, Other Diagnostic Dental Services, Prophylaxis (Cleaning) with no copay, Fluoride Treatment, Other Preventive Dental Services, Orthodontic Services, Restorative Services with no copay, Adjunctive General Services with no copay, Endodontics with no copay, Periodontics with no copay, Prosthodontics (removable) with no copay, Maxillofacial Prosthetics with no copay, Implant Services, Prosthodontics (fixed) with no copay, Oral and Maxillofacial Surgery with no copay, and Orthodontics. Oral exams are limited to 2 visits per year, and dental x-rays are limited to 2 series of bitewing films every year and 1 panoramic film every 3 years.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Simply More (HMO) plan covers Durable Medical Equipment with no copay and 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a 20% coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, lab services with no copay, diagnostic radiological services with a copay up to $100, therapeutic radiological services with a copay up to $50, and outpatient X-ray services with no copay. Prior authorization and a doctor's referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply More (HMO) plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Simply More (HMO) plan with prior authorization and a doctor referral required. There is no copay for days 1-20, and a $40 copay for days 21-100.
Other Services See details
The Simply More (HMO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $105. The plan also covers a Meal Benefit with no copay, but Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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