A non-government entity
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 Broward. 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.
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:
Sign up for Simply More (HMO)
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 More (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs for up to a 3-month supply at preferred and standard pharmacies. This provides excellent cost savings on common generic medications. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply. Tier 4 non-preferred drugs require a $95 copay at preferred pharmacies or a $100 copay at standard pharmacies for a 1-month supply. 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 copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. Outpatient procedures and diagnostic tests feature no coinsurance and low to no copays, while emergency room visits require a $150 copay that is waived upon admission. Skilled nursing facility stays are also highly affordable, offering no copay for the first 20 days. Essential supplemental benefits like dental, routine vision, and hearing services are covered with no copay and no coinsurance up to generous annual limits. Additionally, members receive a monthly $72 allowance for over-the-counter items and unlimited transportation to plan-approved locations at no cost. While most services require no coinsurance, select items such as dialysis and certain medical equipment may require up to a 20% coinsurance.
Inpatient Hospital See details
Simply More (HMO) covers acute and psychiatric inpatient hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. While the plan provides three additional days for acute care, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply More (HMO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $50 copay for substance abuse sessions, and copays up to $100 for outpatient hospital and observation services. Prior authorization and referrals are required for most of these outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply More (HMO) plan 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 $125 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved health-related locations, but transportation to non-approved health-related locations is not covered.
Emergency Services See details
Simply More (HMO) covers emergency services with a $150 copay and urgently needed services with a $15 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with a $150 copay and no coinsurance.
Primary Care See details
Simply More (HMO) offers primary care, specialist visits, telehealth, and routine podiatry services with no copay and no coinsurance, although chiropractic services are not covered. Physical, occupational, and speech therapy, as well as mental health and psychiatric services, are covered with a $15 copay and no coinsurance, while opioid treatment requires a $50 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under Simply More (HMO) with no copay and no coinsurance for covered options like Medicare-covered preventive services, health education, memory fitness, and glaucoma screenings. Uncovered services under this benefit include 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 More (HMO), providing exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance up to a $2,000 yearly limit. However, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply More (HMO), featuring no copay and no coinsurance for yearly routine eye exams and eyewear up to a $300 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply More (HMO) with no copay and no coinsurance, excluding implant services and orthodontics which are not covered. Covered preventive and comprehensive dental care has a $1,200 annual maximum, and certain services require prior authorization.
Home Infusion bundled Services See details
Simply More (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B chemotherapy and other drugs require 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 coinsurance and prior authorization requirements vary by item. Durable medical equipment features no copay and ranges from no coinsurance to 20% coinsurance, prosthetics and medical supplies require no copay and 20% coinsurance, and diabetic equipment is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Simply More (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay of $0 to $100, and diagnostic and therapeutic radiological services have copays starting at $0.
Home Health Services See details
Home Health Services are covered under the Simply More (HMO) plan with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Simply More (HMO) plan. This lack of coverage applies to intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, meaning there are no covered benefits, copays, or coinsurance.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers Skilled Nursing Facility (SNF) services for up to 100 days with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Simply More (HMO) provides partial coverage for Other Services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and certain OTC items like naloxone are not covered, but the plan includes a monthly OTC allowance of $72 for eligible items such as nicotine replacement therapy.
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