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Simply More Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply More Platinum (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply More Platinum (HMO) in 2026, please refer to our full plan details page.
Simply More 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 More 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 More 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 More 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 $50.00. 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 $3400.00 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 More Platinum (HMO) plan offers comprehensive prescription drug coverage starting with a $0 drug deductible, which means your benefits begin immediately. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 6 supplemental drugs across preferred, standard, and standard mail-order pharmacies. For Tier 4 non-preferred drugs, there is a $30 copay for a one-month supply at preferred and standard mail-order pharmacies, or a $35 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Simply More Platinum (HMO) plan offers robust medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and home health services. Outpatient care is highly affordable, featuring no coinsurance and outpatient hospital copays ranging from no copay to $50. Emergency room visits carry a $75 copay, which is waived upon hospital admission, while urgent care visits require no copay. In addition to core medical care, this plan provides generous supplemental benefits with no copay or coinsurance for routine dental, vision, and hearing services. Key allowances include up to $1,200 annually for dental care, $400 for eyewear, $2,000 for hearing aids, and a $45 monthly allowance for over-the-counter items. Members also enjoy unlimited transportation to plan-approved locations and preventive care with no copay.
Inpatient Hospital See details
Simply More Platinum (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. The benefit is partially covered, as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Simply More Platinum (HMO) covers outpatient services with no coinsurance, featuring a $0 to $50 copay for outpatient hospital services and a $50 copay for observation services and substance abuse sessions. Ambulatory surgical center services and outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Simply More Platinum (HMO) plan with no copay and no coinsurance, though prior authorization and referrals are required.
Ambulance and Transportation Services See details
Simply More Platinum (HMO) covers ground ambulance services with a $75 copay and air ambulance services with a 20% coinsurance, requiring prior authorization for both. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Simply More Platinum (HMO) covers emergency services with a $75 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with a $75 copay and no coinsurance per service.
Primary Care See details
Simply More Platinum (HMO) features primary care, specialist, mental health, therapy, and telehealth services with no copay and no coinsurance, while chiropractic services are not covered. Opioid treatment program services are covered with a $50 copay and no coinsurance.
Preventive Services See details
Simply More Platinum (HMO) partially covers preventive services with no copays and no coinsurance for covered benefits, though some services require referrals or prior authorization. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Simply More Platinum (HMO) with no copay, no coinsurance, and no deductible for Medicare-covered exams, routine exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Simply More Platinum (HMO) provides partially covered vision services with no copay and no coinsurance for routine eye exams and eyewear, which includes a combined maximum benefit of $400 per year for contacts and eyeglasses. While routine eye exams and standard eyewear are covered, other eye exam services and eyewear upgrades are not covered by the plan.
Dental Services See details
Dental services are partially covered under the Simply More Platinum (HMO) plan with no copay and no coinsurance for covered services, up to a $1,200 annual maximum. While preventive and comprehensive benefits like cleanings, exams, and restorative treatments are covered, implant services and orthodontics are not covered, and prior authorization is required for certain services.
Home Infusion bundled Services See details
Simply More Platinum (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Simply More Platinum (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Simply More Platinum (HMO) plan, featuring no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. DME and prosthetics require prior authorization and carry up to a 20% coinsurance, while diabetic equipment is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Simply More Platinum (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab and outpatient X-ray services have no copay, while diagnostic procedures and tests carry a copay of $0 to $25, and radiological services feature copays starting at $0.
Home Health Services See details
Simply More Platinum (HMO) covers Home Health Services with no copay and no coinsurance, though both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Simply More Platinum (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization and referral requirements. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Simply More Platinum (HMO) covers skilled nursing facility services with no coinsurance, requiring prior authorization and a referral but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $60 daily copay, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Simply More Platinum (HMO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $45 monthly for OTC items, and the meal benefit has no maximum limit.
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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.
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