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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 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 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 amounts depending on the drug tier and pharmacy type. Preferred Generic and Specialty Tier drugs have no copay, Standard Generic drugs have a $35 copay, and Preferred Brand drugs have copays of $85 or $90. Non-Preferred drugs have a 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Simply More (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and preventive services often have no copay. The plan covers emergency services, primary care, hearing, vision, and dental, typically with no copay for many services, and includes coverage for home health and skilled nursing facilities. This plan also includes additional benefits such as ambulance and transportation services, home infusion, and medical equipment. There are some copays for specific services, like ambulance and some prescription drugs, as well as coinsurance for services like dialysis and certain medical equipment. The plan also covers 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. For Inpatient Hospital-Acute, there is a $50 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $50 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered for 3 days with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Simply More (HMO) plan, with a $0-$100 copay for outpatient hospital services, no copay for observation services and ambulatory surgical center services, and a $50 copay for individual and group outpatient substance abuse sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply More (HMO) plan, and requires prior authorization and a doctor referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, with a limit of 24 one-way trips per year, while transportation services to any health-related location are 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 have a $135 copay, while Urgently Needed Services has no copay. Worldwide Emergency Services has a maximum benefit coverage of $100,000.
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, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, individual and group mental health sessions, podiatry services, other health care professional, psychiatric services, and additional telehealth benefits have no copay. The plan does not cover routine chiropractic care. Opioid treatment program services have a $50 copay.
Preventive Services See details
Preventive Services are covered, with some services requiring a doctor's referral. Medicare-covered preventive services, Health Education, Personal Emergency Response System (PERS), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Fitness Benefit all have no copay. Annual Physical Exams, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids, as well as OTC hearing aids. Hearing exams have no copay, and prescription hearing aids have a maximum benefit of $1500 every year.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for any of the listed services. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, with a limit of one routine eye exam, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one eyeglass frame per year. There is a combined maximum plan benefit coverage amount of $300 for eyewear.
Dental Services See details
The Simply More (HMO) plan covers dental services, including Medicare dental services and other dental services, with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services. Other services have limitations.
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 and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Simply More (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The Simply More (HMO) plan covers Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with no copay, and coinsurance applies. Diabetic Equipment is covered, with Medicare-covered Diabetes Supplies and Therapeutic Shoes/Inserts having no copay, and the plan may limit diabetic supplies to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $100, Therapeutic Radiological Services have a copay up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but some services are not covered. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply More (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
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 $75.00 per month. The plan also covers a Meal Benefit with no copay, but does not cover Acupuncture, Dual Eligible SNPs with Highly Integrated Services, or several other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services.
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