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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 2025, 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 Palm Beach. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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:
Sign up for Simply More (HMO)
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Drug Coverage
The Simply More (HMO) plan has an enhanced alternative drug benefit, and a $0 deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs at preferred, standard, or standard mail pharmacies. For standard generic drugs, you will pay a $25 copay, and for preferred brand drugs, you will pay an $85 copay at preferred pharmacies and a $90 copay at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Simply More (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including some mental health and substance abuse services, have copays. You'll find no copays for many services, including primary care visits, preventive services, hearing and vision exams, and dental services. Emergency services and ambulance services have copays or coinsurance, and home health services have no copay. The plan also covers medical equipment, diagnostic services, and home infusion services with specific copays or coinsurance. There are also some additional benefits like an over-the-counter benefit and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage under the Simply More (HMO) plan includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, the copay is $50, and for days 6-90, there is no copay. Additional days and non-Medicare-covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services are covered by Simply More (HMO), with varying copays depending on the specific service. Outpatient Hospital Services have a copay between $0 and $100, Observation Services and Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services also have no copay. Outpatient Substance Abuse services include individual and group sessions, both with a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply More (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $250 copay, and air ambulance services with 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Simply More (HMO) plan. Emergency Services have a $135 copay, and Urgently Needed Services have a $10 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $135 copay.
Primary Care See details
The Simply More (HMO) plan covers 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. Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have no copay. Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a $15 copay. Occupational Therapy Services, Physical Therapy, and Speech-Language Pathology Services have a $15 copay. Opioid Treatment Program Services have a $50 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, and additional preventive services with a copay for certain services. The Annual Physical Exam, In-Home Safety Assessment, 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, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, up to a maximum of $2000 per year, with no copay for prescription hearing aids (all types).
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered by the Simply More (HMO) plan. There is no copay for eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses; however, upgrades are not covered. Eyewear has a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, and prophylaxis (cleaning) with no copay; fluoride treatment and orthodontics are not covered, and implant services are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are also covered with no copay, though some have limits on the number of visits or specific services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Simply More (HMO), including Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance on certain supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and radiological services, are covered under the Simply More (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of at most $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply More (HMO) plan. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Simply More (HMO) with prior authorization and a doctor referral required. There is no copay for days 1-20, and a $55 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and a Meal Benefit, with no copay for either. 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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