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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 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 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 $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 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 a $590 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs at a standard pharmacy, you'll pay a $3 copay, or 14% coinsurance. Preferred brand drugs have a 25% coinsurance, and non-preferred drugs also have a 25% coinsurance. The specialty tier has no copay.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with a focus on low-cost access to care. Many services come with no copay, including inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, dental services, and home health services. The plan also includes additional benefits like coverage for over-the-counter items and meal benefits, and covers ambulance, emergency, and transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with no copay. Additional days for Inpatient Hospital-Acute and Psychiatric, Non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. There is no copay for outpatient hospital services, observation services, ambulatory surgical center 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 under the Simply Complete (HMO D-SNP) plan, with no copay required and a doctor referral and prior authorization needed.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Simply Complete (HMO D-SNP) plan. Ground and air ambulance services have no coinsurance, and transportation services to a plan-approved health-related location are covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by 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, and a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care benefits include coverage for 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, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a $0 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered under the Simply Complete (HMO D-SNP) plan. Medicare-covered preventive services, including those with no copay, and Kidney Disease Education Services, are covered with no copay. The plan does not cover annual physical exams, In-Home Safety Assessments, 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, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services. The plan also covers Additional Preventive Services, with no copay for services like Health Education, Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
The Simply Complete (HMO D-SNP) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and covers routine hearing exams with no copay for 1 visit per year. Prescription hearing aids are covered up to $2,000 per year, and OTC hearing aids are covered up to $500 per year.
Vision Services See details
The Simply Complete (HMO D-SNP) plan covers vision services, including eye exams, routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is no copay for eye exams, routine eye exams, eyewear, and contact lenses. Eyewear has a combined maximum benefit of $400 per year.
Dental Services See details
The Simply Complete (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. Oral exams are limited to 2 visits per year, dental x-rays are limited to 3, prophylaxis (cleaning) is limited to 2 visits per year, endodontics is limited to 1 visit per year, periodontics is limited to 1 visit every 3 years, prosthodontics (removable) is limited to 1 set of dentures every 5 years and 1 denture adjustment reline every year, prosthodontics (fixed) is limited to 2 fixed partial dentures (bridges) - pontics and retainers, retainer crowns (limit 1 per tooth every 5 years), and oral and maxillofacial surgery is limited to 6 extractions per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Complete (HMO D-SNP) plan. Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs have no copay.
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
Medical Equipment is covered by the Simply Complete (HMO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no coinsurance and no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no coinsurance and no copay.
Diagnostic and Radiological Services See details
The Simply Complete (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay of at most $0, therapeutic radiological services with a copay of at most $0, and outpatient X-ray services with no copay. Prior authorization and a doctor's referral are required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by 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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required, and there is a copay for covered services.
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. Prior authorization and a doctor referral are required for SNF.
Other Services See details
Under the "Other Services" benefit, the Simply Complete (HMO D-SNP) plan covers over-the-counter items with no copay and a maximum benefit coverage amount of $130.00 per month, 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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