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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 Palm Beach. 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 $10.20. 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 $590 deductible. During the initial coverage phase, after the deductible is met, you will pay 25% coinsurance for tiers 1-4 at standard pharmacies, and no copay for tier 5 drugs. During the catastrophic coverage phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with a focus on minimizing out-of-pocket costs. Many services, including inpatient and outpatient hospital care, emergency services, primary care, hearing and vision exams, dental services, and home health services, have no copay. Additionally, the plan covers a range of other services, such as ambulance, transportation, and medical equipment, with no coinsurance. This plan emphasizes preventive care and includes coverage for preventive services. It also provides benefits for prescription hearing aids (up to $2000 annually) and eyewear. The plan also covers home infusion services and dialysis with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered by Simply Complete (HMO D-SNP). There is no copay for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. There is no copay for individual and group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Complete (HMO D-SNP) plan, with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
The Simply Complete (HMO D-SNP) plan covers ambulance and transportation services, including both ground and air ambulance services with no coinsurance, and transportation services to plan-approved health-related locations with no copay. Transportation services to any health-related location are 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 and no coinsurance. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and the plan covers up to $100,000 for these services.
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, 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. The copay for other services is listed in the details.
Preventive Services See details
Preventive Services are covered by the Simply Complete (HMO D-SNP) plan. Medicare-covered preventive services require prior authorization and a doctor referral, while annual physical exams are not covered.
Hearing Services See details
The Simply Complete (HMO D-SNP) plan covers hearing exams and routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $2000 per year and no copay, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Simply Complete (HMO D-SNP) plan covers vision services, including routine eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay, while eyeglass frames are limited to one pair per year. Upgrades are not covered.
Dental Services See details
Simply Complete (HMO D-SNP) covers dental services including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, and oral and maxillofacial surgery with no copay. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Simply Complete (HMO D-SNP) plan. With this plan, you will have no copay for Medicare Part B Insulin Drugs, and no copay for Medicare Part B Chemotherapy/Radiation Drugs, and no copay for Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Simply Complete (HMO D-SNP) plan with no copay. There is also no coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. There is no coinsurance for DME, Prosthetic Devices, or Medical Supplies. Copays may apply for certain diabetic supplies and services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Lab Services, Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Therapeutic Radiological Services have no copay, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Complete (HMO D-SNP) 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 covered with prior authorization and a doctor's referral, though the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for the covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required.
Other Services See details
The Simply Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) items and Meal Benefits with no copay. 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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