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Simply Extra Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Extra Platinum (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Extra Platinum (HMO) in 2025, please refer to our full plan details page.
Simply Extra Platinum (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Simply Extra Platinum (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 Platinum (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 Platinum (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 $164.90. 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 $2450.00 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 Extra Platinum (HMO) plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, preferred generic drugs and specialty tier drugs have no copay, while standard generic drugs have a $47 copay. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Simply Extra Platinum (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while many outpatient services have no copay. Emergency services come with a copay, while transportation services are limited to specific health-related locations with no copay, and include air and ground ambulance services. This plan covers many primary care services, preventive services, and hearing and vision services, all with no copays. Dental services are covered up to a $1,000 annual maximum, and the plan includes coverage for home infusion and dialysis services. Additionally, medical equipment, diagnostic services, and home health services are covered at varying costs.
Inpatient Hospital See details
Inpatient Hospital coverage under the Simply Extra Platinum (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $50 copay for days 1-5, and no copay for days 6-90; however, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $50, observation services with a $50 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $50 copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization and doctor referrals may be required.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Extra Platinum (HMO) plan, requiring prior authorization and a doctor referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
The Simply Extra Platinum (HMO) plan covers ambulance and transportation services, with prior authorization required. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay and offer 12 one-way trips per year using rideshare, bus/subway, van, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Simply Extra Platinum (HMO) plan include coverage for emergency services, urgently needed services, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation. Emergency services have a $120 copay, and urgently needed services have no copay, while worldwide emergency services have a $120 copay for each of the listed services.
Primary Care See details
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 are covered under the Simply Extra Platinum (HMO) plan. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services (Individual and Group Sessions), Additional Telehealth Benefits, and Podiatry Services have no copay. Occupational Therapy Services have a $15 copay. Physical Therapy and Speech-Language Pathology Services have a $15 copay. Opioid Treatment Program Services have a $50 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The Simply Extra Platinum (HMO) plan covers preventive services, including Medicare-covered services with no copay, additional preventive services with no copay for Health Education, and no copay for Fitness Benefit. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits are also covered with no copay.
Hearing Services See details
Hearing Services includes hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay, while prescription hearing aids have a $1,000 maximum plan benefit coverage every year, with no copay for all types of hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and contact lenses are unlimited. Eyeglasses (lenses and frames), and eyeglass lenses and frames, are each limited to one per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,000 per year. Preventive services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, have no copay. Other services such as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Simply Extra Platinum (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Simply Extra Platinum (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered; Prosthetics/Medical Supplies have no copay and 20% coinsurance for Medicare-covered items; and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $75, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply Extra Platinum (HMO) 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 not covered by the Simply Extra Platinum (HMO) plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply Extra Platinum (HMO) plan, but require prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $60.
Other Services See details
The Simply Extra Platinum (HMO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, and 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. The OTC benefit has a maximum coverage amount of $45.00 per month and includes Nicotine Replacement Therapy (NRT).
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