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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 2025, 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 2025.
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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1900.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay no copay for preferred and standard generic drugs, and also no copay for specialty tier drugs. For preferred brand drugs, the copay is $30.00 at preferred pharmacies and $35.00 at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Simply More Platinum (HMO) plan offers a wide range of benefits with varying costs. Many services, including primary care visits, outpatient blood services, preventive services, and dental services, have no copay. The plan also provides coverage for hearing and vision services, including prescription hearing aids up to $2000 per year, and eyewear up to $400 per year. Other benefits include coverage for inpatient and outpatient services, ambulance and transportation, and home health services with no copays. Diagnostic and radiological services have copays between $0 and $25, while emergency services have a $50 copay. The plan also offers an over-the-counter (OTC) benefit with a maximum coverage of $90 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a doctor referral and prior authorization. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay and an additional 3 days are covered, with no copay per day, while Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is also no copay for a Medicare-covered stay, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Simply More Platinum (HMO) plan. Outpatient Hospital Services have a copay between $0 and $50, Observation Services have a $50 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $50. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply More Platinum (HMO) plan, requiring prior authorization and a doctor referral. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $75 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Simply More Platinum (HMO) plan. Emergency Services have a $50 copay, while Urgently Needed Services have no copay; Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $50 copay.
Primary Care See details
The Simply More Platinum (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and routine foot care have no copay. Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services are covered, and include Medicare-covered zero dollar preventive services, which require prior authorization and a doctor referral. Annual physical exams are not covered, but additional preventive services are covered, including Health Education, Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, all with no copay. Kidney Disease Education Services are covered with no copay, and Other Preventive Services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
The Simply More Platinum (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a plan-specified amount of $2000 per year, with no copay for prescription hearing aids of all types for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; OTC hearing aids are also not covered.
Vision Services See details
The Simply More Platinum (HMO) plan covers eye exams and eyewear, including services not usually covered by Medicare plans. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay. Eyewear has a combined maximum benefit of $400 every year, and upgrades are not covered.
Dental Services See details
Simply More Platinum (HMO) covers dental services with no copay for Medicare dental services, oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, and oral and maxillofacial surgery. Fluoride treatment, implant services, and orthodontics are not covered, and some services have limitations on the number of visits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Simply More Platinum (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by Simply More Platinum (HMO), with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20%. Prosthetic devices and medical supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and diagnostic radiological services, have a copay between $0 and $25. Lab services and outpatient X-ray services have no copay, while therapeutic radiological services have a copay of at most $25.
Home Health Services See details
Home Health Services are covered by the Simply More 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 More Platinum (HMO) plan. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered or non-Medicare-covered stays. Prior authorization and a doctor referral are required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, but 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 includes a maximum coverage amount of $90.00 per month.
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