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Simply Complete Platinum (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Complete Platinum (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Complete Platinum (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Complete Platinum (HMO D-SNP) is a HMO D-SNP 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 Complete Platinum (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Complete Platinum (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply Complete Platinum (HMO D-SNP).
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 Complete Platinum (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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 Complete Platinum (HMO D-SNP) Medicare prescription drug plan features an annual drug deductible of $615. Fortunately, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacies or standard mail order services. This coverage applies to one-month, two-month, and three-month supplies. For other medication categories, the plan requires a 25% coinsurance. This 25% coinsurance rate applies to Tier 2 generic and Tier 3 preferred brand drugs for one, two, or three-month supplies. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty drugs are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) offers comprehensive healthcare coverage with no copays and no coinsurance for almost all core medical services, including inpatient hospital stays, outpatient care, and primary or specialist visits. Members also benefit from no copays on diagnostic services, skilled nursing facility stays up to 100 days, and emergency care worldwide up to a $100,000 maximum limit. While these essential medical services are covered with no out-of-pocket costs, many do require prior authorization or referrals. This plan also includes valuable supplemental benefits with no copays or coinsurance, such as a $1,500 annual limit for dental services, a $400 eyewear allowance, and up to $2,000 annually for prescription hearing aids. Additionally, members can access unlimited one-way transportation to plan-approved health locations and a $130 monthly over-the-counter drug allowance. These extensive benefits are designed to support your daily wellness and specialized care needs at no extra cost.
Inpatient Hospital See details
Simply Complete Platinum (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Simply Complete Platinum (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and no coinsurance. Prior authorization and referrals are required for most of these services, and the deductible for outpatient blood services is fully waived.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, offering unlimited one-way trips to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Simply Complete Platinum (HMO D-SNP) covers emergency and urgently needed services with no copays and no coinsurance. Worldwide emergency coverage, urgent care, and emergency transportation are also covered with no copays or coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Complete Platinum (HMO D-SNP) covers primary care, specialist visits, mental health, therapy, podiatry, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance for covered care. Sub-services that are not covered include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Hearing services are partially covered by Simply Complete Platinum (HMO D-SNP), offering Medicare-covered exams, one routine hearing exam, and one fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with a $2,000 maximum benefit and no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Simply Complete Platinum (HMO D-SNP), featuring routine eye exams and eyewear with no copay, no coinsurance, and no deductible. Covered eyewear includes contact lenses and eyeglasses up to a $400 combined annual limit, while other eye exam services and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance up to a maximum annual limit of $1,500. This coverage includes preventive and various comprehensive dental services, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Complete Platinum (HMO D-SNP) covers home infusion bundled services, including Medicare Part B insulin, chemotherapy, and other Part B drugs, with no copay and no coinsurance. Prior authorization is required for these services, and step therapy may apply.
Dialysis Services See details
Simply Complete Platinum (HMO D-SNP) covers dialysis services with no copay and no coinsurance.
Medical Equipment See details
Simply Complete Platinum (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and no coinsurance. Prior authorization is required for these benefits, and some equipment must be sourced from preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Simply Complete Platinum (HMO D-SNP) covers diagnostic and radiological services, including lab work, x-rays, and therapeutic radiology, with no copays and no coinsurance. Prior authorization and referrals are required for these services.
Home Health Services See details
Simply Complete Platinum (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Simply Complete Platinum (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. This benefit is partially covered as prior authorization and referrals are required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Simply Complete Platinum (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance, which includes a $130 monthly over-the-counter (OTC) drug allowance and meal benefits for qualifying medical conditions, though acupuncture is not covered.
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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.
* 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.
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