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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 Clay, Duval, St. Johns. 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:
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Drug Coverage
The Simply More (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs and specialty tier drugs have no copay, while standard generic drugs have a $35 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Simply More (HMO) plan offers a range of benefits with varying costs. You'll have a $75 copay for inpatient hospital stays for the first four days, with no copay for days 5-90. Outpatient services and many primary care services have no copay, while others have copays ranging from $10 to $50. This plan includes coverage for hearing, vision, and dental services, all with no copays for many services such as eye exams, hearing exams, and dental cleanings. Additionally, you'll find coverage for ambulance and transportation services, emergency services, and home health services, with some services having copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage under the Simply More (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor referral. For days 1-4, there is a $75 copay, and for days 5-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered for 3 days with no copay. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $75, while observation services, ambulatory surgical center services, and outpatient blood services have no copay. Outpatient substance abuse services for individual and group sessions have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply More (HMO) plan and requires prior authorization and a doctor 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 $200 copay, air ambulance services with 20% coinsurance, and transportation services to a plan-approved health-related location 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 by the Simply More (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $135 copay, while Urgently Needed Services has no copay.
Primary Care See details
The Simply More (HMO) plan covers Primary Care Physician Services with no copay. Chiropractic Services are covered with no copay, but routine care is not covered. Occupational Therapy Services have a $15 copay. Physician Specialist Services have a $10 copay. Mental Health Specialty Services have a $10 copay for individual and group sessions. Podiatry Services and Other Health Care Professional services have no copay. Psychiatric Services have a $10 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $15 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, but require prior authorization and a doctor referral. Additional preventive services like Health Education, Personal Emergency Response System, and Fitness Benefit are covered with no copay. Other services like Annual Physical Exams, In-Home Safety Assessments, Medical Nutrition Therapy, and several others are not covered.
Hearing Services See details
The Simply More (HMO) plan covers hearing exams and routine hearing exams with no copay. Fitting/evaluation for hearing aids has no copay, and prescription hearing aids are covered up to a maximum of $2,000 every year with no copay. OTC hearing aids are covered up to $500 per year.
Vision Services See details
The Simply More (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Contact lenses are unlimited, while eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are limited to one per year, and upgrades are covered.
Dental Services See details
The Simply More (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, and other preventive services with no copay. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, oral and maxillofacial surgery, and orthodontics with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply More (HMO) plan. Medicare Part B Insulin Drugs have 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 More (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by Simply More (HMO), with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20%, and no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay, and Diabetic Supplies and Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Simply More (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $50, lab services with no copay, diagnostic radiological services with a copay up to $90, therapeutic radiological services with a copay up to $60, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Simply More (HMO) plan with no copay and no coinsurance. However, 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. Services including Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply More (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $150 copay for days 21-100, and additional and non-Medicare days are not covered.
Other Services See details
The Simply More (HMO) plan's "Other Services" benefit covers over-the-counter items with no copay, and a monthly maximum of $90, and a meal benefit 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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