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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 Broward. 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 will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at preferred, standard, and mail order pharmacies. For standard generic drugs, the copay is $25.00 at preferred and standard pharmacies, and $25.00 at mail order pharmacies. Once your total drug costs reach $2000.00, 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 a focus on low-cost care. Many services have no copay, including inpatient hospital stays, outpatient services, preventive services, hearing exams, vision services, and dental services. The plan also covers ambulance and transportation services, emergency services, and a variety of primary care services with various copays. This plan also includes benefits for home health services, dialysis services, and medical equipment with no copays. Additionally, the plan provides coverage for over-the-counter items and a meal benefit for chronic illnesses. Some services, like skilled nursing facility stays, have copays associated with them.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor's referral, with no copay. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $100, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $50 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization and doctor referrals are required for some services.
Partial Hospitalization See details
Simply More (HMO) covers partial hospitalization with no copay. Prior authorization and a doctor referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply More (HMO) plan, with prior authorization required. Ground ambulance services have a $125 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay. 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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay, and Urgently Needed Services has a $15 copay.
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, Physician Specialist Services, and Additional Telehealth Benefits have no copay. Occupational Therapy, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services have a $15 copay. Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Opioid Treatment Program Services have a $50 copay. Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services require prior authorization and a doctor referral.
Preventive Services See details
The Simply More (HMO) plan covers preventive services, including Medicare-covered services with no copay, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit with no copay. The plan does not cover annual physical exams.
Hearing Services See details
The Simply More (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2,000 every year with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are covered up to $500 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum of $300 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with no copay, and other dental services. Oral exams, Dental X-Rays, Prophylaxis (Cleaning), Restorative Services, Endodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery all have a $0 copay, with limits on the number of visits or procedures.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Simply More (HMO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, with a 20% coinsurance for Medical Supplies and a coinsurance between 20% and 20% for Prosthetic Devices. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, Lab Services with no copay, Diagnostic Radiological Services with a copay between $0 and $100, Therapeutic Radiological Services with a copay between $0 and $60, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered under the Simply More (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referrals are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply More (HMO) plan. Prior authorization and a doctor referral are required for coverage, but the plan does not cover any of the listed cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply More (HMO) plan, with a $0 copay for days 1-20 and a $55 copay for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The Simply More (HMO) plan covers over-the-counter items with no copay, up to a maximum of $55 per month, and also covers a meal benefit with no copay for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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