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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 2026, 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 2026.
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) Medicare plan features a $0 prescription drug deductible, meaning your coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs for up to a three-month supply at preferred, standard, or standard mail-order pharmacies. This makes everyday medications highly affordable and accessible for members. For Tier 3 preferred brand drugs, the plan requires a copay of $15 for a one-month supply, which scales to $45 for a three-month supply. Tier 4 non-preferred drugs cost a $75 copay at preferred and standard mail-order pharmacies, or an $80 copay at standard pharmacies for a one-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across all available pharmacy options.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers comprehensive medical coverage with many essential services featuring no copays or coinsurance, including inpatient hospital stays, primary care, specialist visits, and preventative care. For emergency services, members pay a $150 copay, while urgent care visits require no copay. Diagnostic services and lab tests also feature no coinsurance, with most basic services requiring no copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing services with no copays or coinsurance up to specific annual limits. Additionally, members benefit from up to 24 one-way transportation trips per year with no copay or coinsurance, alongside a monthly allowance for over-the-counter items. Specialized care such as physical therapy requires a low $15 copay, while durable medical equipment and dialysis carry coinsurance up to 20% with no copay.
Inpatient Hospital See details
Simply Level (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. While the plan includes up to 3 additional days for acute stays, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Level (HMO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $100, observation services require a $100 copay per stay, and outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Level (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Level (HMO C-SNP), with prior authorization required. Ground ambulance services require a $200 copay, air ambulance services require 20% coinsurance, and transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations (transportation to any health-related location is not covered).
Emergency Services See details
Simply Level (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay 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 require a $150 copay and no coinsurance up to a $100,000 maximum benefit.
Primary Care See details
Simply Level (HMO C-SNP) covers primary care, specialist visits, podiatry, and telehealth services with no copay and no coinsurance, though chiropractic services are not covered. Physical, occupational, speech, mental health, and psychiatric therapies require a $15 copay and no coinsurance, while opioid treatment services have a $50 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Simply Level (HMO C-SNP) with no copay and no coinsurance for covered services, which include Medicare-covered preventive care, kidney disease education, and select supplemental benefits. However, several services are not covered under this plan, such as annual physical exams, weight management programs, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by Simply Level (HMO C-SNP), offering Medicare-covered exams, routine exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance, up to a $2,000 annual limit. However, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Simply Level (HMO C-SNP) offers partially covered vision services with no copay and no coinsurance for covered benefits, including one routine eye exam per year and up to $300 annually for contact lenses or eyeglasses. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Simply Level (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance up to a $1,200 annual maximum. Covered services include preventive care, oral exams, and cleanings, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Level (HMO C-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Level (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level (HMO C-SNP) covers medical equipment, offering durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Prosthetic devices and medical supplies are covered with no copay and 20% coinsurance, while diabetic equipment and supplies are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Level (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay ranging from $0 to $100.
Home Health Services See details
Simply Level (HMO C-SNP) offers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Simply Level (HMO C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Simply Level (HMO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Simply Level (HMO C-SNP) plan, which offers a chronic illness meal benefit and up to $35 monthly for over-the-counter items with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered.
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