A non-government entity
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 2026, 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 2026.
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 $4.80. 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 $615.00 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:
Sign up for Simply Complete (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply Complete (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies. For Tier 2 generic and Tier 3 preferred brand medications, the plan charges a 25% coinsurance for standard pharmacy and mail order fills across all supply durations. Tier 4 non-preferred drugs and Tier 5 specialty tier drugs also require a 25% coinsurance for a one-month supply.
Additional Benefits
The Simply Complete (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for the vast majority of its medical services. Beneficiaries can access inpatient and outpatient hospital stays, primary and specialist care, emergency services, and unlimited medical transportation to plan-approved locations at no cost. Additionally, standard medical equipment, diagnostic lab tests, and home health services are covered with no copayments or coinsurance. This plan also includes valuable supplemental benefits, such as dental care up to $1,500 annually, a $2,000 hearing aid allowance, and $400 yearly for eyewear, all with no copays or deductibles. Members also benefit from a $100 monthly allowance for over-the-counter items with no out-of-pocket costs. Note that some exceptions apply, such as a 20% coinsurance for dialysis and therapeutic radiology, and many services require prior authorization or referrals.
Inpatient Hospital See details
Simply Complete (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. These benefits are partially covered, as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Simply Complete (HMO D-SNP) covers outpatient services, including outpatient hospital care, ambulatory surgical center services, substance abuse sessions, and blood services, with no copays and no coinsurance. Prior authorization and referrals are required for most of these covered services.
Partial Hospitalization See details
Simply Complete (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Complete (HMO D-SNP) with no copays and no coinsurance, though prior authorization is required. This benefit is partially covered, offering unlimited one-way trips to plan-approved locations via rideshare, van, medical transport, or transit, while transportation to any health-related location is not covered.
Emergency Services See details
Simply Complete (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum benefit limit of $100,000.
Primary Care See details
Simply Complete (HMO D-SNP) covers primary care, specialist visits, occupational and physical therapy, mental health, and telehealth services with no copay and no coinsurance. Routine podiatry is also covered for up to 12 visits per year with no copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for covered options like kidney disease education, glaucoma screenings, and select home safety devices. However, several services are not covered under this plan, including annual physical exams, weight management programs, and in-home safety assessments.
Hearing Services See details
Simply Complete (HMO D-SNP) covers hearing exams and prescription hearing aids with no deductible, no copays, and no coinsurance, including a $2,000 annual maximum for hearing aids. However, hearing services are only partially covered, as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, including one routine eye exam and up to $400 yearly for contact lenses or eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Complete (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum benefit of $1,500 every year. Covered services include preventive and comprehensive care like cleanings, exams, x-rays, and oral surgery, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Complete (HMO D-SNP) covers Home Infusion bundled services with no copay and no coinsurance, although prior authorization is required. This coverage includes Medicare Part B chemotherapy, radiation, insulin, and other Part B drugs, all of which are offered with no copay and no coinsurance.
Dialysis Services See details
Simply Complete (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance for durable medical equipment (DME), prosthetics, medical supplies, and diabetic services. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Simply Complete (HMO D-SNP) covers diagnostic procedures, lab tests, and diagnostic radiological services with no copays and no coinsurance. Outpatient X-rays also have no copay, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorization and referrals required for all services.
Home Health Services See details
Simply Complete (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Simply Complete (HMO D-SNP) with no copay and no coinsurance, but prior authorization and a referral are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Simply Complete (HMO D-SNP) for days 1 through 100 with no copayment and no coinsurance, though prior authorization and a referral are required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Complete (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illness and up to $100 monthly for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved