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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 Palm Beach. 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) prescription drug plan features an annual drug deductible of $615. Fortunately, members pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacies or standard mail order. This coverage applies to one, two, and three-month supplies of these medications. For other tiers, you will pay a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance applies to Tier 2 generic and Tier 3 preferred brand drugs for up to a three-month supply, as well as one-month supplies of Tier 4 non-preferred drugs and Tier 5 specialty drugs. These structured costs help you easily plan your monthly healthcare expenses.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for almost all covered medical services. Members can access inpatient and outpatient hospital care, emergency services, primary care, and specialist visits at no cost. This includes crucial services like diagnostic tests, medical equipment, dialysis, and home health care, though some services require prior authorization or referrals. Additionally, the plan provides valuable supplemental benefits with no copays or coinsurance, including routine dental care up to a $1,500 yearly limit and vision coverage with a $400 annual eyewear allowance. Members also benefit from a $2,000 prescription hearing aid allowance, unlimited transportation to approved health locations, and a $50 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Simply Complete (HMO D-SNP) partially covers inpatient hospital services, providing Medicare-covered acute and psychiatric stays with no copay and no coinsurance, though prior authorization and referrals are required. Additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Simply Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these covered services.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Simply Complete (HMO D-SNP) covers ground and air ambulance services with no copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, 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 or coinsurance, up to a maximum benefit limit of $100,000.
Primary Care See details
Primary care benefits under Simply Complete (HMO D-SNP) are covered with no copay and no coinsurance for services such as primary care physician visits, specialist care, physical therapy, and mental health sessions. Although chiropractic care is listed as a benefit, routine and other chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for covered benefits, such as Medicare-covered preventive services, glaucoma screenings, and diabetes self-management training. However, several services are not covered under this plan, including annual physical exams, in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Simply Complete (HMO D-SNP) hearing services are partially covered with no copay and no coinsurance for Medicare-covered exams, one routine hearing exam, and one fitting evaluation per year. Prescription hearing aids are covered up to a $2,000 annual maximum, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Complete (HMO D-SNP) with no copay, no coinsurance, and no deductible, including one routine eye exam and up to $400 annually for eyewear. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Complete (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to a $1,500 yearly maximum. While preventive and most comprehensive treatments are covered, implant services and orthodontics are not covered, and certain services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. This benefit also includes coverage for Medicare Part B chemotherapy, insulin, and other Part B drugs with no copay and no coinsurance.
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
Simply Complete (HMO D-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copay and no coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Simply Complete (HMO D-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay and no coinsurance. Prior authorization and referrals are required for these services.
Home Health Services See details
Home health services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply Complete (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, though additional days beyond the Medicare-covered limit are not covered. Prior authorization and referrals are required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
Simply Complete (HMO D-SNP) covers other services with no copay and no coinsurance, providing a chronic illness meal benefit and a $50 monthly over-the-counter item allowance, though acupuncture is not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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