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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 2026, 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 2026.
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 offers prescription drug coverage with a $0 drug deductible, meaning your benefits kick in immediately. You will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Supplemental Drugs) prescriptions for up to a three-month supply at preferred or standard pharmacies. This makes everyday maintenance medications highly affordable and accessible. For Tier 3 (Preferred Brand) drugs, copays start at $10 for a one-month supply, while Tier 4 (Non-Preferred) drugs require a copay of $50 or $55 depending on your pharmacy choice. Specialty drugs in Tier 5 carry a 33% coinsurance for a one-month supply across standard and preferred pharmacies.
Additional Benefits
The Simply Extra Platinum (HMO) plan provides affordable healthcare coverage with no copay and no coinsurance for primary care, specialist visits, preventive care, and home health services. Inpatient hospital stays require a $75 daily copay for the first five days and no copay for subsequent days, while emergency room visits carry a $150 copay that is waived if you are admitted. Most outpatient services and diagnostic lab tests are also highly accessible with no coinsurance and no copay. This plan also features generous supplemental benefits, including comprehensive dental, vision, and hearing coverage with no copays or coinsurance. Members receive up to a $1,200 annual limit for dental treatments, a $200 annual allowance for glasses or contact lenses, and up to $1,000 per year for prescription hearing aids. Additionally, the plan covers up to twelve free one-way transportation trips annually and provides a $20 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Simply Extra Platinum (HMO) inpatient hospital care is partially covered with no coinsurance, requiring a $75 copay per day for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Non-Medicare-covered stays and acute room upgrades are not covered under this benefit, and both prior authorization and referrals are required.
Outpatient Services See details
Simply Extra Platinum (HMO) covers outpatient hospital services with a $0 to $75 copay and no coinsurance, and observation services with a $75 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $50 copay and no coinsurance.
Partial Hospitalization See details
Simply Extra Platinum (HMO) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
Simply Extra Platinum (HMO) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Simply Extra Platinum (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $150 copay and no coinsurance per service.
Primary Care See details
Simply Extra Platinum (HMO) offers primary care, specialist, telehealth, mental health, and podiatry services with no copay and no coinsurance, though some chiropractic services are covered but routine and other chiropractic care are not covered. Physical, occupational, and speech therapy require a $15 copay and no coinsurance, while opioid treatment program services have a $50 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Simply Extra Platinum (HMO) with no copay and no coinsurance for covered benefits, though some services require prior authorization or referrals. Services not covered under this plan include annual physical exams, 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 or dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home or bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered under the Simply Extra Platinum (HMO) plan, offering Medicare-covered exams, one routine exam, and one fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered combined for both ears every year with a $1,000 maximum benefit and no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Simply Extra Platinum (HMO) features partially covered vision services with no copay, no coinsurance, and no deductible. Members receive one routine eye exam per year and a $200 annual allowance for contact lenses or eyeglasses, though other eye exams and eyewear upgrades are not covered.
Dental Services See details
Simply Extra Platinum (HMO) partially covers dental services with no copay and no coinsurance for diagnostic, preventive, and most comprehensive treatments up to a $1,200 annual maximum. While a wide range of services like cleanings, x-rays, and restorative care are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Extra Platinum (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have 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 Extra Platinum (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Extra Platinum (HMO) covers medical equipment with no copay for all categories, including durable medical equipment (DME), prosthetics, and diabetic supplies. DME requires between no coinsurance and 20% coinsurance, prosthetics and medical supplies require 20% coinsurance, and diabetic equipment features no coinsurance.
Diagnostic and Radiological Services See details
Simply Extra Platinum (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab work and a copay of up to $75 for diagnostic procedures. Radiological services are also covered, offering diagnostic radiology and outpatient X-rays with no copay, while therapeutic radiology requires a minimum 20% coinsurance and no copay.
Home Health Services See details
Simply Extra Platinum (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 not covered under the Simply Extra Platinum (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Simply Extra Platinum (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required for this benefit, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Simply Extra Platinum (HMO) partially covers other services, offering over-the-counter (OTC) items up to $20 monthly and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture, naloxone OTC items, and other miscellaneous services are not covered.
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