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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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $33.00. You must continue to pay paying your reduced 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 offers excellent prescription drug coverage with no annual drug deductible, allowing your benefits to start immediately. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental medications for one-month, two-month, or three-month supplies at preferred and standard pharmacies. This zero-cost coverage on essential generics helps keep your routine healthcare expenses low. For higher-tier medications, costs vary depending on the drug classification and your choice of pharmacy. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs have a $95 copay at preferred pharmacies and a $100 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Simply More (HMO) plan offers comprehensive medical coverage with no copays for primary care visits, telehealth, and preventive services, while specialist visits require a low $10 copay. For hospital care, inpatient stays feature a $125 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $150 copay that is waived upon admission. Outpatient services and diagnostic tests like lab work and X-rays are also highly affordable, featuring no coinsurance and mostly no copays. This plan also provides robust additional benefits, including routine dental, vision, and hearing care with no copays, alongside generous annual allowances of up to $1,200 for dental work, $400 for eyewear, and $2,000 for prescription hearing aids. Members benefit from a $35 monthly over-the-counter allowance, a chronic illness meal benefit, and up to 24 free one-way transportation trips per year to approved health locations. Essential medical equipment, home health visits, and dialysis are also covered, with dialysis and durable medical equipment carrying up to a 20% coinsurance and no copay.
Inpatient Hospital See details
Simply More (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $125 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Outpatient services under Simply More (HMO) are covered with no coinsurance across all services, including ambulatory surgical center and outpatient blood services which also require no copays. Medicare-covered outpatient hospital visits have a copay of $0 to $125, observation services require a $125 copay per stay, and outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Simply More (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Simply More (HMO) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Simply More (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 limit with a $150 copay and no coinsurance.
Primary Care See details
Simply More (HMO) primary care, telehealth, podiatry, and other health professional services are available with no copay and no coinsurance, while specialist, mental health, and psychiatric visits require a $10 copay and no coinsurance. Physical and occupational therapy services have a $15 copay and no coinsurance, opioid treatment requires a $50 copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Simply More (HMO) with no copays and no coinsurance for covered benefits, which include Medicare-covered zero-dollar preventive services, health education, and a memory fitness benefit. However, several sub-services are not covered under this plan, including the annual physical exam, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
Simply More (HMO) covers hearing services with no copay and no coinsurance for Medicare-covered exams, annual routine exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services under Simply More (HMO) are partially covered, offering routine eye exams and eyewear with no copay and no coinsurance, up to a $400 annual maximum for eyewear. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Simply More (HMO) with no copay and no coinsurance for covered preventive and comprehensive services, up to a $1,200 annual maximum. Orthodontics and implant services are not covered under this plan.
Home Infusion bundled Services See details
Simply More (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Simply More (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply More (HMO) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes are covered with no coinsurance.
Diagnostic and Radiological Services See details
Simply More (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services, outpatient X-rays, and therapeutic or diagnostic radiological services, while diagnostic procedures and tests have a copay ranging from $0 to $50.
Home Health Services See details
Home Health Services are covered by Simply More (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Simply More (HMO) with no copay and no coinsurance, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Simply More (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral, but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply More (HMO), featuring a meal benefit for chronic illness and a $35 monthly allowance for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, Naloxone, and other miscellaneous services are not covered under this benefit.
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