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Simply Level (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level (HMO C-SNP) in 2025, please refer to our full plan details page.
Simply Level (HMO C-SNP) is a HMO C-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 Level (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level (HMO C-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 Level (HMO C-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 Level (HMO C-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 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:
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Drug Coverage
The Simply Level (HMO C-SNP) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay the following copays: $0 for preferred generic and specialty tier drugs, $15 for standard generic drugs, and $75-$80 for preferred brand drugs. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Simply Level (HMO C-SNP) plan offers a wide range of benefits with varying costs. This plan covers inpatient hospital stays with a $50 copay for days 1-5, and no copay for days 6-90. Outpatient services, primary care, preventive services, and many other services have no copay. Additional benefits include coverage for hearing aids up to $2000 per year, vision services, and extensive dental services with no copay for many procedures. The plan also provides coverage for emergency services, ambulance services, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage under the Simply Level (HMO C-SNP) plan includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization and a doctor referral. For days 1-5, there is a $50 copay, and for days 6-90, there is no copay; however, additional days and non-Medicare-covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a copay between $0 and $100, and Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay. Outpatient Substance Abuse services have a $50 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Level (HMO C-SNP) plan. This benefit has no copay and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply Level (HMO C-SNP) plan. Ground Ambulance Services have a $150 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply Level (HMO C-SNP) plan. Emergency Services have a $135 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay, with a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with no copay (prior authorization and referral required), Occupational Therapy Services with a $15 copay, Physician Specialist Services with no copay, Mental Health Specialty Services with a $15 copay for individual and group sessions (prior authorization and referral required), Podiatry Services with no copay, Other Health Care Professional with no copay (prior authorization and referral required), Psychiatric Services with a $15 copay for individual and group sessions (prior authorization and referral required), Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $50 copay (prior authorization and referral required). Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, but 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. Medicare-covered preventive services and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit have no copay. Health education, personal emergency response system, fitness benefit, remote access technologies, and home and bathroom safety devices and modifications have no copay.
Hearing Services See details
The Simply Level (HMO C-SNP) plan covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $2000 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, including routine eye exams and eyewear, are covered. Routine eye exams and eyewear have no copay, and there is a combined maximum benefit of $300 every year for eyewear.
Dental Services See details
Dental services are covered with no copay for Medicare dental services, oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Other covered dental services include fluoride treatment, other preventive dental services, and orthodontics.
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 Level (HMO C-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Level (HMO C-SNP) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Simply Level (HMO C-SNP) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay between $0 and $100, Therapeutic Radiological Services have a copay between $0 and $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply Level (HMO C-SNP) plan with no copay and no coinsurance, but 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 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. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply Level (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $40 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Simply Level (HMO C-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, and the plan offers a $60 monthly benefit. 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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