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 2026, please refer to our full plan details page.

This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.

Simply Complete (HMO D-SNP) is a HMO D-SNP plan offered by Simply Healthcare Plans, Inc. available for the 2026 plan year to people living in Broward. This plan received an overall rating of 4.5 out of 5 stars in 2026.

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.

Overview IconKey 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 $4.80. 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

Health deductible: information not available.

This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.

Out-of-Pocket Maximums

This plan has a Maximum Out-Of-Pocket cost of $500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $500.00 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:

Regular visits to your primary care doctor are covered and will have a coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care are covered and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Simply Complete (HMO D-SNP)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.

Drug Coverage IconDrug Coverage

The Simply Complete (HMO D-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supplies. For other medication categories, members are responsible for a 25% coinsurance rate at standard pharmacies and standard mail order services. This 25% coinsurance applies to Tier 2 generic and Tier 3 preferred brand drugs for up to a three-month supply, as well as Tier 4 non-preferred and Tier 5 specialty drugs for a one-month supply. This structure helps you easily project your out-of-pocket prescription costs throughout the year.

Additional Benefits IconAdditional Benefits

The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with no copays, no coinsurance, and no deductibles for most covered medical services. Members can access inpatient and outpatient hospital care, primary care, specialist visits, and emergency services worldwide with zero out-of-pocket costs. Additionally, essential services like diagnostics, dialysis, medical equipment, and unlimited transportation to approved health locations are fully covered with no copay. This plan also features robust supplemental benefits, including dental care up to $1,500 annually, vision coverage with a $400 eyewear allowance, and hearing aids up to $2,000 per year, all with no copay. Other valuable perks include home health services, skilled nursing care, a chronic illness meal benefit, and a $55 monthly allowance for over-the-counter items. While many services require prior authorization or referrals, the plan ensures broad coverage without financial barriers for its members.

Inpatient Hospital See details

Inpatient hospital care is partially covered by Simply Complete (HMO D-SNP), offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.

Outpatient Services See details

Outpatient services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for outpatient hospital care, ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services. Prior authorization and referrals are required for most of these covered outpatient benefits.

Partial Hospitalization See details

Simply Complete (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, although prior authorization and a referral are required.

Ambulance and Transportation Services See details

Ambulance and transportation services are covered under Simply Complete (HMO D-SNP) with no copays and no coinsurance, though prior authorization is required. Medicare-covered ground and air ambulance services are fully covered, while transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations but excluding trips to any health-related location.

Emergency Services See details

Simply Complete (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.

Primary Care See details

Simply Complete (HMO D-SNP) offers primary care, specialist, therapy, mental health, and podiatry services with no copay and no coinsurance. Chiropractic services are not covered under this plan.

Preventive Services See details

Preventive services are partially covered by Simply Complete (HMO D-SNP) with no copays and no coinsurance for covered services, though some benefits require referrals or prior authorization. Several supplemental services are not covered under this plan, including annual physical exams, medical nutrition therapy, in-home safety assessments, and weight management programs.

Hearing Services See details

Hearing services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids, which feature a $2,000 maximum annual limit. However, OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.

Vision Services See details

Simply Complete (HMO D-SNP) partially covers vision services with no copays, no coinsurance, and no deductibles, including one routine eye exam per year and up to $400 annually for eyewear like contact lenses and eyeglasses. Other eye exam services and eyewear upgrades are not covered.

Dental Services See details

Simply Complete (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to a maximum plan benefit of $1,500 per year. While most preventive and comprehensive dental care is covered, implant services and orthodontics are not covered, and prior authorization is required for certain treatments.

Home Infusion bundled Services See details

Simply Complete (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Covered Part B drugs under this benefit, including insulin and chemotherapy, are also provided with no copays and no coinsurance.

Dialysis Services See details

Dialysis Services are covered under the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance.

Medical Equipment See details

Simply Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and no coinsurance. Prior authorization is required for these services, and some equipment and supplies may be limited to preferred vendors or specified manufacturers.

Diagnostic and Radiological Services See details

Simply Complete (HMO D-SNP) covers diagnostic and radiological services, including lab tests, diagnostic procedures, therapeutic radiology, and X-rays, with no copay and no coinsurance. Prior authorization and referrals are required for these covered services.

Home Health Services See details

Home health services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.

Cardiac Rehabilitation Services See details

Simply Complete (HMO D-SNP) does not cover cardiac rehabilitation services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) services.

Skilled Nursing Facility (SNF) See details

Simply Complete (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization and a referral are required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.

Other Services See details

Simply Complete (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illnesses and a $55 monthly allowance for over-the-counter items with no copay and no coinsurance. Acupuncture and dual-eligible SNPs with highly integrated services are not covered.

Plan Providers IconPlan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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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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