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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 Hernando, Hillsborough, Pasco, Pinellas. 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 different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you'll have no copay for preferred generic drugs at preferred and standard pharmacies, and a $35 copay for standard generic drugs. For non-preferred drugs, you'll pay 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Simply More (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have a copay depending on the service. Many services have no copay, including primary care, hearing exams, vision services, dental services, home health, and skilled nursing for the first 20 days. Additional benefits include ambulance and transportation services, emergency services, and coverage for home infusion services. The plan also covers medical equipment, diagnostic and radiological services, and offers OTC items and meal benefits with no copay. However, the plan does not cover cardiac rehabilitation services and has limitations on some services.
Inpatient Hospital See details
Inpatient Hospital coverage under the Simply More (HMO) plan includes a $50 copay for days 1-8 and no copay for days 9-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered under the Simply More (HMO) plan. Outpatient hospital services have a copay between $0 and $100, while observation services, ambulatory surgical center services, and outpatient blood services have no copay. Outpatient substance abuse services are covered with a copay of $50 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply More (HMO) plan, with a doctor referral and prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year. 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, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $135 copay, while Urgently Needed Services have no copay.
Primary Care See details
The Simply More (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, 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, while physical therapy and speech-language pathology services have a $15 copay. Occupational therapy, mental health specialty services, and psychiatric services have a $15 copay for individual and group sessions, and opioid treatment program services have a $50 copay.
Preventive Services See details
Preventive Services are covered, including additional services not usually covered by Medicare plans. Medicare-covered preventive services and Kidney Disease Education Services have no copay, while additional preventive services may have a copay.
Hearing Services See details
Simply More (HMO) covers hearing exams with no copay, as well as routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2000 every year, and OTC hearing aids are covered up to $500 every year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for any of the services. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. Eyewear has a combined maximum plan benefit of $400.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. Oral exams are limited to 2 visits per year, dental x-rays are limited to 2 bitewing series every year and 1 panoramic film every 3 years, prophylaxis (cleaning) is limited to 2 visits per year, endodontics is limited to 1 visit per year, periodontics is limited to 1 scaling/root planing per quadrant every three years, prosthodontics (removable) is limited to 1 set of complete or partial dentures every five years and 1 denture adjustment reline every year, prosthodontics (fixed) is limited to 2 fixed partial dentures (bridges) - pontics and retainers, retainer crowns (limit 1 per tooth every 5 years), and oral and maxillofacial surgery is limited to 6 extractions every year.
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.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Medical Supplies and Prosthetic Devices have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Simply More (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $100, and lab services with no copay. The plan also covers diagnostic radiological services with a copay up to $100, therapeutic radiological services with a copay up to $60, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply More (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply More (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Under the Simply More (HMO) plan, Over-the-Counter (OTC) Items and Meal Benefits are covered with no copay. 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.
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