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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 Hernando, Hillsborough, Pasco, Pinellas. 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 $10.00. 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 Level (HMO C-SNP) Medicare plan offers a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs for up to a three-month supply at standard or preferred pharmacies. This makes managing daily medications highly affordable with zero out-of-pocket costs for these common drug tiers. For Tier 3 preferred brand drugs, copays are $30 for a one-month supply at standard and preferred pharmacies, increasing to $90 for a three-month supply. Tier 4 non-preferred drugs carry a $75 copay at preferred pharmacies or standard mail order and an $80 copay at standard pharmacies for a one-month supply. Specialty drugs in Tier 5 require a 33% coinsurance for a one-month supply across all available pharmacy options.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers robust healthcare coverage with no copay 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 the first five days and no copay for the remaining covered days, while emergency room visits carry a $150 copay that is waived upon admission. Outpatient procedures and services are highly affordable, requiring no coinsurance and copays that range from no copay up to $100. Members also benefit from comprehensive dental, vision, and hearing care with no copay, featuring generous annual allowances like $1,000 for dental services, $300 for eyewear, and $2,000 for prescription hearing aids. While many routine services have no copay, specialized treatments such as dialysis, chemotherapy, and durable medical equipment require a 0% to 20% coinsurance. Additionally, the plan supports daily living by offering up to 24 free one-way trips to plan-approved locations and a $30 monthly allowance for over-the-counter health items.
Inpatient Hospital See details
Simply Level (HMO C-SNP) inpatient hospital services are partially covered 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, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Simply Level (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $100 copay, observation services have a $100 copay per stay, and outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Simply Level (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access 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, with prior authorization required. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Simply Level (HMO C-SNP) 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 and no 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 Level (HMO C-SNP) provides primary care, specialist visits, telehealth, and routine podiatry services with no copay and no coinsurance, though chiropractic services are not covered in practice. Therapy services, including physical, occupational, speech, mental health, and psychiatric sessions, require a $15 copay and no coinsurance, while opioid treatment programs carry a $50 copay and no coinsurance.
Preventive Services See details
Simply Level (HMO C-SNP) provides partial coverage for preventive services with no copays and no coinsurance for covered benefits like kidney disease education, glaucoma screenings, diabetes self-management, and select fitness benefits. However, several sub-services are not covered, including annual physical exams, weight management programs, nutritional or dietary benefits, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Simply Level (HMO C-SNP), offering Medicare-covered exams, routine exams, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to a $2,000 annual maximum with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models 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, although other eye exam services and eyewear upgrades are not covered. Covered benefits include one routine eye exam per year and up to $300 annually for eyewear, including contact lenses, eyeglass lenses, and frames, with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by Simply Level (HMO C-SNP) with no copay and no coinsurance for covered services, up to a maximum annual benefit of $1,000. While preventive care and various comprehensive procedures are covered, 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, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance and no copay, 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 Level (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level (HMO C-SNP) covers medical equipment, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and diabetic supplies and therapeutic shoes with no copay and no coinsurance. Prosthetic devices and medical supplies are also covered with no copay and a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Simply Level (HMO C-SNP) covers diagnostic and radiological services with no coinsurance, requiring prior authorization and referrals for these services. Lab services and outpatient X-rays feature no copay, diagnostic procedures and tests have a copay between $0 and $100, and diagnostic or therapeutic radiological services have a minimum copay of $0.
Home Health Services See details
Simply Level (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Simply Level (HMO C-SNP) plan with no copay and no coinsurance, although 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) care is 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 days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Simply Level (HMO C-SNP) provides partial coverage for other services, including a chronic illness meal benefit and over-the-counter (OTC) items up to $30 per month with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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