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 2026, please refer to our full plan details page.

This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.

Simply Complete (HMO D-SNP) is a HMO D-SNP plan offered by Simply Healthcare Plans, Inc. available for the 2026 plan year to people living in Orange, Osceola, Seminole, Volusia. This plan received an overall rating of 4.5 out of 5 stars in 2026.

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.

Overview IconKey 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 $4.80. 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

Health deductible: information not available.

This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.

Out-of-Pocket Maximums

This plan has a Maximum Out-Of-Pocket cost of $500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $500.00 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:

Regular visits to your primary care doctor are covered and will have a coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care are covered and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Simply Complete (HMO D-SNP)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.

Drug Coverage IconDrug Coverage

The Simply Complete (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies of these medications. For other drug tiers, you will typically pay a 25% coinsurance at standard pharmacies and standard mail order services. This 25% coinsurance rate applies to Tier 2 generic and Tier 3 preferred brand drugs for all supply lengths, as well as one-month supplies of Tier 4 non-preferred drugs and Tier 5 specialty drugs.

Additional Benefits IconAdditional Benefits

The Simply Complete (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for most essential services, including inpatient and outpatient hospital care, primary and specialist visits, preventive care, and emergency services. While most healthcare services cost nothing out of pocket, a 20% coinsurance applies to dialysis and therapeutic radiological services. Additionally, members benefit from covered medical equipment, home health services, and skilled nursing facility stays for up to 100 days at no cost. This plan also features robust supplemental benefits, including dental care up to $1,200 annually, vision exams and eyewear up to a $350 annual limit, and hearing aids up to $1,500 per year, all with no copays or deductibles. Members also receive unlimited one-way rides to plan-approved medical locations, an $80 monthly allowance for over-the-counter items, and chronic illness meal benefits at no extra cost. These additional perks make it easier to manage daily health needs without worrying about unexpected expenses.

Inpatient Hospital See details

Simply Complete (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though referrals and prior authorization are required. Additional days, non-Medicare-covered stays, and upgrades are not covered under this benefit.

Outpatient Services See details

Simply Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these covered outpatient services.

Partial Hospitalization See details

Simply Complete (HMO D-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required for this benefit.

Ambulance and Transportation Services See details

Simply Complete (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance, though prior authorization is required. Transportation is partially covered, offering unlimited one-way rides to plan-approved health-related locations via rideshare, van, medical transport, or public transit, while trips to non-approved health-related locations are not covered.

Emergency Services See details

Emergency services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for emergency and urgently needed care. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $100,000.

Primary Care See details

Simply Complete (HMO D-SNP) covers primary care, specialist visits, physical therapy, mental health, and podiatry services with no copay and no coinsurance. Chiropractic services are not covered under this plan, as both routine and other chiropractic sub-services are excluded from coverage.

Preventive Services See details

Simply Complete (HMO D-SNP) covers preventive services with no copay and no coinsurance, although some services require prior authorization or referrals. This benefit is partially covered, as annual physical exams, in-home safety assessments, medical nutrition therapy, weight management programs, alternative therapies, and therapeutic massages are not covered.

Hearing Services See details

Simply Complete (HMO D-SNP) covers routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual limit for both ears combined, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.

Vision Services See details

Simply Complete (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and eyewear like contact lenses or eyeglasses up to a $350 annual limit, while other eye exam services and upgrades are not covered.

Dental Services See details

Dental services are partially covered by Simply Complete (HMO D-SNP), offering preventive and comprehensive care with no copay and no coinsurance up to a maximum annual benefit of $1,200. While most restorative, endodontic, and oral surgery services are covered, implant services and orthodontics are not covered.

Home Infusion bundled Services See details

Simply Complete (HMO D-SNP) covers home infusion bundled services, including Medicare Part B chemotherapy, insulin, and other drugs, with no copay and no coinsurance. Prior authorization and step therapy are required for these services.

Dialysis Services See details

Dialysis services are covered under the Simply Complete (HMO D-SNP) plan with no copay and a 20% coinsurance.

Medical Equipment See details

Simply Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and no coinsurance. Prior authorization is required for these services, and certain items must be obtained from preferred vendors or specified manufacturers.

Diagnostic and Radiological Services See details

Simply Complete (HMO D-SNP) covers diagnostic and radiological services, offering no copays and no coinsurance for lab services, diagnostic tests, diagnostic radiology, and outpatient X-rays. However, therapeutic radiological services require a 20% coinsurance, and prior authorization and referrals are required for all services.

Home Health Services See details

Home health services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.

Cardiac Rehabilitation Services See details

Simply Complete (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.

Skilled Nursing Facility (SNF) See details

Simply Complete (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, although referrals and prior authorization are required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.

Other Services See details

Other services are partially covered by Simply Complete (HMO D-SNP), which offers no copay and no coinsurance for chronic illness meal benefits and up to $80 monthly for over-the-counter items. Acupuncture is not covered under this plan.

Plan Providers IconPlan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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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.

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