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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 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 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 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) Medicare 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) medications at preferred pharmacies, standard pharmacies, and standard mail order. This ensures that many common prescription drugs are available to you at no cost. For higher-tier prescriptions, Tier 3 (Preferred Brand) drugs have a $35 copay for a one-month supply. Tier 4 (Non-Preferred) drugs require an $85 copay at preferred pharmacies and standard mail order, or a $90 copay at standard pharmacies for a one-month supply. Specialty medications in Tier 5 carry a 33% coinsurance rate for a one-month supply across all pharmacy options.
Additional Benefits
The Simply More (HMO) plan offers comprehensive coverage with no copays or coinsurance for primary care, specialist visits, telehealth, and preventive care. For inpatient hospital stays, members pay a fifty dollar daily copay for the first eight days and no copay for days nine through ninety. Outpatient hospital services, lab tests, and urgent care are also highly accessible, with low to no copays and no coinsurance. Beyond standard medical care, the plan features strong supplemental benefits including no copays for dental services up to a one thousand dollar annual limit and vision care with a four hundred dollar eyewear allowance. Members also receive no-copay hearing exams with up to two thousand dollars for prescription hearing aids, twenty-four free one-way transportation trips, and a thirty dollar monthly over-the-counter allowance. Other essential services like durable medical equipment and dialysis require no copays and coinsurance up to twenty percent.
Inpatient Hospital See details
Simply More (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 through 8 and no copay for days 9 through 90. This inpatient benefit is partially covered because room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Simply More (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $100 copay and observation services with a $100 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $50 copay per session and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Simply More (HMO) 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 $200 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Simply More (HMO) covers emergency services with a $145 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $145 copay and no coinsurance.
Primary Care See details
Simply More (HMO) features primary care, specialist, telehealth, and routine podiatry visits with no copay and no coinsurance, though chiropractic services are not covered. Mental health, psychiatric, and physical, occupational, or speech therapy services require a $15 copay and no coinsurance, while opioid treatment program services carry a $50 copay and no coinsurance.
Preventive Services See details
Simply More (HMO) offers partial coverage for preventive services, providing Medicare-covered zero-dollar preventive care, health education, memory fitness, and select screenings with no copay and no coinsurance. However, several services are not covered under this plan, including annual physical exams, medical nutrition therapy, and in-home safety assessments.
Hearing Services See details
Simply More (HMO) covers hearing services with no copay and no coinsurance, including annual routine exams, fitting evaluations, and up to $2,000 annually for prescription hearing aids. This benefit is partially covered, as OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply More (HMO) with no copay, no coinsurance, and no deductible, though other eye exam services and eyewear upgrades are not covered. The plan includes one routine eye exam per year and a $400 annual maximum benefit for eyewear, which covers contact lenses, eyeglass lenses, and frames.
Dental Services See details
Dental services are partially covered by Simply More (HMO) with no copay and no coinsurance for covered services, up to a $1,000 annual maximum. Covered care includes preventive and comprehensive services like exams, cleanings, and surgical procedures, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply More (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
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 durable medical equipment (DME) with no copay and 0% to 20% coinsurance, and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Simply More (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, a $0 to $100 copay for diagnostic procedures and tests, and a minimum $0 copay for diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Simply More (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Simply More (HMO) with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply More (HMO) provides partially covered other services with no copay and no coinsurance, including meals for chronic illnesses and a $30 monthly allowance for over-the-counter items. Acupuncture and other additional services are not covered under this plan.
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