A non-government entity
Simply Extra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Extra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Extra (HMO) in 2026, please refer to our full plan details page.
Simply Extra (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 Extra (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 Extra (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 Extra (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 $125.00. 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:
Sign up for Simply Extra (HMO)
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 Extra (HMO) plan features no drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs at preferred and standard pharmacies. Tier 2 generic drugs are also available with no copay when filled through standard mail order, or for a copay starting at $10 for a one-month supply at retail pharmacies. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies. Tier 4 non-preferred drugs carry a one-month copay of $95 at preferred pharmacies and standard mail order, or $100 at standard pharmacies. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Simply Extra (HMO) plan offers comprehensive coverage with no copay for primary care visits, preventive services, and routine dental, vision, and hearing exams. Specialist visits require a $35 copay, while inpatient hospital stays carry a $325 daily copay for the first five days before dropping to no copay. Additionally, members can take advantage of valuable allowances, including up to $1,000 annually for both dental care and hearing aids, alongside a $200 annual limit for eyewear, all with no copays. For emergency and urgent needs, there is a $150 emergency room copay and a $40 urgent care copay. Diagnostic labs and x-rays are available with no copay, while dialysis and durable medical equipment require up to a 20% coinsurance. The plan also supports daily health needs by providing up to 12 one-way transportation trips per year and a $40 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Simply Extra (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, but additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
Simply Extra (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copays. Outpatient hospital services carry a $0 to $200 copay, observation services require a $200 copay per stay, and outpatient substance abuse sessions have a $40 copay, with prior authorization and referrals required for most care.
Partial Hospitalization See details
Simply Extra (HMO) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Simply Extra (HMO) covers ambulance services with a $250 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Simply Extra (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered up to a $100,000 lifetime maximum with a $150 copay and no coinsurance per service.
Primary Care See details
Simply Extra (HMO) offers primary care, telehealth, and routine podiatry services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapy, as well as mental health services, are covered with a $40 copay and no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services are partially covered under the Simply Extra (HMO) plan with no copay and no coinsurance for covered care, though some services require referrals or prior authorization. Sub-services not covered include the annual physical exam, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Simply Extra (HMO) covers hearing exams, including routine and fitting evaluations, with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 maximum annual benefit, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Simply Extra (HMO) offers partially covered vision services with no deductible, no copay, and no coinsurance, including one routine eye exam and up to $200 annually for eyewear such as contacts or eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Extra (HMO) dental services are partially covered with no copay and no coinsurance, though implant services and orthodontics are not covered. Covered services include preventive cleanings, exams, and select restorative treatments up to a $1,000 yearly maximum, with prior authorization required for some procedures.
Home Infusion bundled Services See details
Simply Extra (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply Extra (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Extra (HMO) covers medical equipment, including durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Covered prosthetics, medical supplies, and diabetic equipment feature no copay and no coinsurance, though prior authorization is required for all of these services.
Diagnostic and Radiological Services See details
Simply Extra (HMO) covers diagnostic and radiological services, with lab services, outpatient X-rays, and diagnostic radiological services having no copays. Diagnostic tests and procedures carry a copay of $0 to $200 with no coinsurance, while therapeutic radiological services require a minimum $40 copay and a minimum 20% coinsurance.
Home Health Services See details
Simply Extra (HMO) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Simply Extra (HMO) with no copay and no coinsurance, though in practice only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Simply Extra (HMO) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply Extra (HMO), featuring no copay and no coinsurance for chronic illness meal benefits and over-the-counter (OTC) items up to $40 per month, while acupuncture is not covered.
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