A non-government entity
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 Orange, Osceola, Seminole. 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 $55.00. 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:
Sign up for Simply Level (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply Level (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 supplemental drugs for up to a three-month supply at both preferred and standard pharmacies. This makes everyday essential medications highly affordable and accessible. For brand-name and specialty medications, the plan structures costs based on drug tiers. Tier 3 preferred brands require a $20 copay for a one-month supply, while Tier 4 non-preferred drugs cost $65 at preferred pharmacies and standard mail order, or $70 at standard pharmacies. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply across all retail and standard mail-order options.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care, specialist visits, preventive services, and home health care. For inpatient hospital stays, members pay a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. Outpatient surgical services and urgent care also require no copays, while emergency room visits carry a $145 copay that is waived if admitted. This plan provides strong supplemental benefits, including no copays or coinsurance for dental care up to $1,500 annually and hearing services with a $1,500 annual hearing aid allowance. Vision benefits include a routine eye exam and up to $300 yearly for eyewear with no copays. Additionally, routine transportation is covered for up to 24 free one-way trips per year, and durable medical equipment is available with no copay and up to 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital acute and psychiatric care are covered by Simply Level (HMO C-SNP) with no coinsurance, requiring a $50 daily copay for days 1 to 5 and no copay for days 6 to 90. The benefit is partially covered because upgrades and non-Medicare-covered stays are not covered, though acute care includes up to 3 additional days with no copay.
Outpatient Services See details
Simply Level (HMO C-SNP) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center services and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $100 (with a $100 copay per stay for observation services), while outpatient substance abuse individual and group sessions require a $50 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Simply Level (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
Simply Level (HMO C-SNP) covers ground ambulance services with a $200 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Routine transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Simply Level (HMO C-SNP) covers emergency services with a $145 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $145 copay and no coinsurance per service.
Primary Care See details
Simply Level (HMO C-SNP) covers primary care, specialist visits, physical therapy, telehealth, and mental health 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) partially covers preventive services with no copay and no coinsurance for covered services, including Medicare-covered zero-dollar preventive services, kidney disease education, diabetes training, glaucoma screenings, and select supplemental benefits like memory fitness and health education. However, several services are not covered under this plan, including annual physical exams, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing Services are partially covered by Simply Level (HMO C-SNP), offering Medicare-covered exams, routine exams, fitting evaluations, and prescription hearing aids up to $1,500 annually with no copay and no coinsurance. However, OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Level (HMO C-SNP) with no copay, no coinsurance, and no deductible for covered services, including one routine eye exam per year and up to $300 annually for eyewear such as contacts, lenses, and frames. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Level (HMO C-SNP) features partially covered dental services with no copay and no coinsurance, up to a maximum plan benefit of $1,500 per year. Preventive and comprehensive care like exams, cleanings, and restorative services are covered, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Level (HMO C-SNP) 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 have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Simply Level (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level (HMO C-SNP) covers durable medical equipment (DME) with no copay and up to 20% coinsurance, while prosthetics and medical supplies require a 20% coinsurance and no copay. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required across these medical equipment benefits.
Diagnostic and Radiological Services See details
Simply Level (HMO C-SNP) 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 a copay of $0 to $100, and other radiological services start at a $0 copay.
Home Health Services See details
Home health services are covered by Simply Level (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Simply Level (HMO C-SNP) with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Simply Level (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Simply Level (HMO C-SNP) partially covers other services, providing over-the-counter (OTC) items up to $35 monthly and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved