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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 2025, please refer to our full plan details page.
Simply Complete (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Orange, Osceola, Seminole. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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.
Key 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 $2.30. 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 $500.00 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 Complete (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible is met, you will pay 25% coinsurance for most drugs. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers a wide range of benefits with a focus on low-cost access to care. Many services, including inpatient and outpatient hospital services, primary care, preventive services, hearing, vision, and dental services, and home health services, are available with no copay. Additionally, the plan covers emergency services, ambulance services, and transportation to health-related locations, often with no copay, and offers coverage for over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Complete (HMO D-SNP) plan, with no copay required. Prior authorization and a doctor referral are needed for this benefit.
Ambulance and Transportation Services See details
The Simply Complete (HMO D-SNP) plan covers ambulance services with no coinsurance and a copay for Medicare-covered ground and air ambulance services, as well as transportation services to plan-approved health-related locations with no copay. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply Complete (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation also have no copay and no coinsurance.
Primary Care See details
Primary care services include 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, occupational therapy services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Chiropractic services and mental health specialty services have a $0 copay for Medicare-covered services, while podiatry services and opioid treatment program services also have a $0 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, with Medicare-covered services requiring prior authorization and a doctor referral. The plan does not cover annual physical exams, and the cost sharing for additional preventive services depends on the service, but may include a copay. Health Education, Personal Emergency Response System (PERS), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Simply Complete (HMO D-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1500 per year with no copay, while OTC hearing aids are covered with a maximum benefit of $500 per year. However, prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. There is no copay for eye exams, eyewear, contact lenses, eyeglass lenses, or eyeglass frames, and a combined maximum benefit of $350.00 per year for all eyewear.
Dental Services See details
Dental Services are covered, including Medicare dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. There is no copay for many 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Complete (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay, and Other Medicare Part B Drugs have a minimum and maximum copayment of $0.00.
Dialysis Services See details
Dialysis Services are covered by the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. There is no coinsurance for any of these services. Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, Medicare-covered Diabetes Supplies, and Medicare-covered Diabetic Therapeutic Shoes or Inserts have a copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic and Therapeutic Radiological Services have a copay, but the maximum copay is $0.
Home Health Services See details
Home Health Services are covered under the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance, but 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 covered, but 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. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required, and the copay information is available in the plan details.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit with no copay, and a $125 maximum plan benefit coverage amount for OTC items. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many additional services are not covered.
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