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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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $20.00. 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 More (HMO) Medicare plan features a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs for up to a three-month supply at preferred, standard, or standard mail-order pharmacies. This makes everyday maintenance medications exceptionally affordable and accessible for members. For brand-name and specialty medications, costs are structured by tier to help you easily budget your healthcare expenses. Tier 3 preferred brand drugs require a $10 copay for a one-month supply, while Tier 4 non-preferred drugs have a $55 copay at preferred pharmacies and a $60 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Simply More (HMO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, specialist consultations, and telehealth services. For hospital stays, members pay a $40 daily copay for the first five days of inpatient care and no copay for days six through 90. Emergency room visits carry a $140 copay, which is waived if admitted, while ground ambulance services require a $200 copay. This plan also provides valuable supplemental benefits with no copays or coinsurance, including routine dental care up to a $1,000 annual limit and vision coverage with a $400 eyewear allowance. Additionally, members receive up to $2,000 annually for prescription hearing aids and a $45 monthly allowance for approved over-the-counter items. Routine transportation is also covered with no copay for up to 24 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Simply More (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $40 daily copay for days 1 to 5 and no copay for days 6 to 90. While up to three additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Simply More (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $100, while observation services cost $100 per stay and outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Simply More (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Simply More (HMO) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Simply More (HMO) covers emergency services with a $140 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $140 copay and no coinsurance.
Primary Care See details
Simply More (HMO) offers primary care, specialist, telehealth, and podiatry services with no copay and no coinsurance, while occupational, physical, and speech therapies require a $15 copay and no coinsurance. Mental health and psychiatric sessions have a $20 copay and no coinsurance, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Simply More (HMO) with no copay and no coinsurance for covered services such as kidney disease education, glaucoma screenings, and fitness benefits. Sub-services that are not covered include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing Services are covered by Simply More (HMO) with no copay, no coinsurance, and no deductible for routine exams, Medicare-covered exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual maximum, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Simply More (HMO), offering one routine eye exam per year and eyewear with no copay, no coinsurance, and no deductible. While contact lenses, eyeglasses, lenses, and frames are covered up to a $400 annual maximum, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply More (HMO) offers partially covered dental services with no copay and no coinsurance, up to a maximum annual benefit of $1,000. Preventive care and most comprehensive services are covered, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply More (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply More (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment (DME) carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies and therapeutic shoes have no coinsurance.
Diagnostic and Radiological Services See details
Simply More (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have copays ranging from $0 to $50.
Home Health Services See details
Home health services are covered by Simply More (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Simply More (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
Simply More (HMO) partially covers other services, providing a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit includes a monthly allowance of $45 for approved items, but does not cover Naloxone.
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