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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 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 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 $40.00. 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) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront deductible costs. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs for 1-month, 2-month, or 3-month supplies at preferred pharmacies, standard pharmacies, and standard mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at both preferred and standard pharmacies. Tier 4 non-preferred drugs carry an $85 copay at preferred pharmacies and standard mail order, or a $90 copay at standard pharmacies, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply.
Additional Benefits
The Simply More (HMO) plan offers robust medical coverage with no copays and no coinsurance for primary care, specialist visits, mental health services, and home health care. Inpatient hospital stays are highly affordable, requiring a $50 daily copay for the first five days and no copay for subsequent days. Outpatient services and diagnostic tests generally range from no copay to a $100 copay, while emergency care carries a $150 copay that is waived upon hospital admission. This plan also features strong supplemental benefits at no copay or coinsurance, including up to $1,200 annually for dental care, a $300 annual eyewear allowance, and up to $1,500 for prescription hearing aids. Members also receive up to 24 free one-way transportation trips per year, a $35 monthly over-the-counter allowance, and diabetic supplies with no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Simply More (HMO) with no coinsurance, requiring a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply More (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services range from no copay to a $100 copay, observation services require a $100 copay per stay, and outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Simply More (HMO) 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 air ambulance services with a 20% coinsurance. 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 $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Simply More (HMO) provides primary care, specialist, mental health, and therapy services with no copay and no coinsurance. Opioid treatment is covered with a $50 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Simply More (HMO) provides partial coverage for preventive services with no copay and no coinsurance for covered benefits, including kidney disease education, glaucoma screenings, diabetes self-management, and select fitness benefits. Several services are not covered under this plan, such as annual physical exams, medical nutrition therapy, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing services are covered under the Simply More (HMO) plan, featuring no copays and no coinsurance for Medicare-covered exams, routine annual exams, and fitting evaluations. Prescription hearing aids are covered up to $1,500 annually with no copay or coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Simply More (HMO) with no copay and no coinsurance for covered services, which include one routine eye exam per year and eyewear up to a $300 annual maximum. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply More (HMO), offering preventive and comprehensive care with no copay and no coinsurance up to a maximum annual benefit of $1,200. Covered benefits include cleanings, exams, and oral surgery, 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, requiring prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no 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 for these services. Durable medical equipment incurs a 0% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are offered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply More (HMO) with no coinsurance, although prior authorization and referrals are required. Outpatient X-rays and lab services feature no copay, diagnostic procedures and tests range from a $0 to $100 copay, and diagnostic and therapeutic radiological services carry a copay starting at $0.
Home Health Services See details
Simply More (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply More (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization and a referral are required for these services.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, but a three-day prior hospital stay is not, and additional days beyond day 100 are not covered.
Other Services See details
Simply More (HMO) provides coverage for select other services with no copay and no coinsurance, including a $35 monthly allowance for over-the-counter (OTC) items and meal benefits for chronic illnesses, while acupuncture is not covered.
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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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