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Simply Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Complete (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Complete (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Citrus, 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 Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Complete (HMO D-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 Complete (HMO D-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 Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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 Complete (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs. This cost-saving benefit applies to one-month, two-month, and three-month fills at both standard retail pharmacies and standard mail order services. For other medication tiers, you will pay a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance rate applies to Tier 2 generic and Tier 3 preferred brand drugs for one, two, or three-month supplies, as well as to Tier 4 non-preferred and Tier 5 specialty drugs for a one-month supply.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for most primary care, specialist, hospital, and emergency services. Beneficiaries also benefit from routine care with no copays, including dental services up to a $1,200 annual limit, vision care with a $400 yearly eyewear allowance, and hearing aids up to $2,000. Additionally, the plan includes unlimited one-way transportation to approved locations and a $55 monthly allowance for over-the-counter items at no cost. While most medical and preventive services require no copay or coinsurance, a 20% coinsurance applies to dialysis and therapeutic radiological services. Skilled nursing facility stays for days 1 through 100 and home health services are also covered with no copay and no coinsurance. Please note that many benefits, including inpatient stays, medical equipment, and outpatient therapies, require prior authorization or referrals.
Inpatient Hospital See details
Simply Complete (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered because additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Simply Complete (HMO D-SNP) with no copays and no coinsurance for outpatient hospital care, ambulatory surgical center services, substance abuse therapy, and blood services. Prior authorization and referrals are required for most of these outpatient benefits.
Partial Hospitalization See details
Simply Complete (HMO D-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Simply Complete (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance, although prior authorization is required. The transportation benefit is partially covered, offering unlimited one-way rides to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Simply Complete (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Primary care benefits are partially covered by Simply Complete (HMO D-SNP), offering no copay and no coinsurance for primary care physician visits, specialist services, therapies, and mental health care. Routine chiropractic care and other chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for covered benefits. Sub-services not covered include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Simply Complete (HMO D-SNP) with no copayments or coinsurance for Medicare-covered exams, routine annual exams, and hearing aid fittings. The plan also provides up to $2,000 annually for up to two prescription hearing aids with no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, though other eye exam services and upgrades are not covered. This benefit includes one routine eye exam annually and up to a $400 yearly maximum for covered eyewear, such as contact lenses and eyeglasses.
Dental Services See details
Simply Complete (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, including a maximum annual benefit of $1,200 for other dental services. While most preventive and comprehensive dental procedures are covered with no copay and no coinsurance, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, which includes coverage for Part B chemotherapy, insulin, and other Part B drugs. Prior authorization is required for these services, and step therapy may apply.
Dialysis Services See details
Dialysis Services are covered under the Simply Complete (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and no coinsurance. Prior authorization is required for these benefits, and certain items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Simply Complete (HMO D-SNP) with no copay and no coinsurance for lab work, diagnostic tests, and outpatient X-rays. Therapeutic radiological services require a 20% coinsurance, and prior authorization and referrals are required for these diagnostic and radiological benefits.
Home Health Services See details
Home health services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Simply Complete (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, but requires prior authorization and a referral. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Simply Complete (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, requiring no prior three-day inpatient hospital stay. Prior authorization and referrals are required for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Simply Complete (HMO D-SNP) partially covers other services, offering a chronic illness meal benefit and up to $55 per month for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other additional services are not covered.
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