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Simply Level (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level (HMO C-SNP) in 2025, please refer to our full plan details page.
Simply Level (HMO C-SNP) is a HMO C-SNP 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 Level (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level (HMO C-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.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply Level (HMO C-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 Level (HMO C-SNP), 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 Level (HMO C-SNP) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs, $15 for standard generic drugs, $75 or $80 for preferred brand drugs, and 33% coinsurance for non-preferred drugs. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient blood services, partial hospitalization, transportation services, and many primary care services. The plan also covers hearing exams, vision services, and dental services with no copays for routine exams and eyewear. Other benefits include coverage for home health services, and over-the-counter items with a monthly allowance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $100, while observation services, ambulatory surgical center services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Level (HMO C-SNP) plan with no copay and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply Level (HMO C-SNP) plan. 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, and the plan covers up to 24 one-way trips per year for rideshare, bus/subway, van, and medical transport. 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 Level (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay, while Urgently Needed Services has no copay.
Primary Care See details
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 are covered. For Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Additional Telehealth Benefits, there is no copay. For Occupational Therapy Services, the copay is $15. For Physical Therapy and Speech-Language Pathology Services, the copay is $15. For Mental Health Specialty Services, Individual and Group Sessions have a minimum copay of $15 and a maximum copay of $15. For Psychiatric Services, Individual and Group Sessions have a minimum copay of $15 and a maximum copay of $15. For Opioid Treatment Program Services, the copay is $50. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services with a doctor referral, and additional preventive services with no copay. Other services are partially covered, and include Health Education, Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. Annual physical exams, In-Home Safety Assessments, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
The Simply Level (HMO C-SNP) plan covers hearing exams with no copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $2000 per year, and OTC hearing aids are covered up to $500 per year.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay, and eyewear has a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics. There is no copay for most services except for Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Simply Level (HMO C-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Level (HMO C-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment benefits are covered by the Simply Level (HMO C-SNP) plan, with a coinsurance of 0% to 20% for Durable Medical Equipment (DME). Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Some services, such as Durable Medical Equipment for use outside the home, are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Simply Level (HMO C-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $100, Therapeutic Radiological Services have a copay up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply Level (HMO C-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Simply Level (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $40 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Simply Level (HMO C-SNP) plan covers over-the-counter (OTC) items with no copay, and offers a monthly benefit of $80.00, as well as a meal benefit 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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