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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 2025, 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 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 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 $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 a $590.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you pay your deductible, you will pay 25% coinsurance for most drugs, and no copay for specialty tier drugs. Once your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers a wide array of benefits with a focus on minimizing out-of-pocket costs. Many services, including inpatient and outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services have no copay. This plan also includes coverage for ambulance and transportation services, emergency services, and skilled nursing facilities, with specific limitations on coverage. The plan also provides additional benefits such as over-the-counter items, and a meal benefit for chronic illnesses. However, it is important to note that certain services like annual physical exams, additional hours of home health care, and specific types of hearing aids are not covered. Prior authorization and doctor referrals are often required for many services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. However, additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under the Simply Complete (HMO D-SNP) plan. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay. Outpatient Substance Abuse services have no copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Complete (HMO D-SNP) plan, with prior authorization and a doctor referral required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for all ambulance services. Ground and Air Ambulance Services have no copay. Transportation Services to a plan-approved health-related location are covered with no copay, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply Complete (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay or coinsurance, while Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit coverage of $100,000.
Primary Care See details
The Simply Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health and psychiatric services, and opioid treatment program services also have no copay.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero-dollar preventive services, with a doctor referral and prior authorization required. The plan does not cover annual physical exams, but does cover additional preventive services, such as Health Education, Personal Emergency Response System (PERS), and Home and Bathroom Safety Devices and Modifications.
Hearing Services See details
The Simply Complete (HMO D-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $2,000 per year, and OTC hearing aids are covered up to $500 per 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, eyewear, and contact lenses. There is no copay for eye exams, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses, and eyeglass frames, also have no copay, and there is a combined maximum benefit of $400 per year.
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, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics with no copay. Oral exams and prophylaxis are limited to 2 visits per year, dental x-rays are limited to 3, endodontics and periodontics are limited to 1 visit per year, prosthodontics (removable) are limited to 2 visits, and oral and maxillofacial surgery are limited to 6 extractions per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Complete (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, or Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. Durable Medical Equipment has no coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no coinsurance and no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay of at most $0, therapeutic radiological services with a copay of at most $0, and outpatient X-ray services with no copay. Prior authorization and a doctor's referral are required.
Home Health Services See details
Home Health Services are covered under the Simply Complete (HMO D-SNP) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the specific services. A referral and prior authorization from your doctor are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor referral are required, and there is a copay for SNF services.
Other Services See details
The Simply Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $105.00 per month, including Nicotine Replacement Therapy (NRT). The plan also provides a meal benefit with no copay for a chronic illness. 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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