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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 2025, 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 2025.
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 $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 a $590.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you will pay coinsurance for your prescriptions. For preferred generic drugs, you will pay 15% coinsurance at standard and mail order pharmacies. For specialty tier drugs, you will pay no copay. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) plan offers a wide range of benefits with no copay for many services. This includes inpatient and outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and more. Additionally, the plan covers over-the-counter items up to $135 per month and meal benefits, both with no copay. While many services have no copay, some services like prescription hearing aids have a maximum benefit of $2000 per year. Some services may require prior authorization or a referral from your doctor. Notably, the plan does not cover cardiac rehabilitation services, and some other services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Simply Complete Platinum (HMO D-SNP) plan, with no copay for Medicare-covered stays. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered with no copay. Outpatient Blood Services includes an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Complete Platinum (HMO D-SNP) plan, with no copay required. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with no coinsurance. Ground and air ambulance services have no copay. Transportation services to a plan-approved health-related location are also covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Simply Complete Platinum (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum benefit coverage of $100,000. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay.
Primary Care See details
The Simply Complete Platinum (HMO D-SNP) plan covers 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 with a $0 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero-dollar preventive services, but annual physical exams are not covered. Additional preventive services, including health education, personal emergency response systems, and fitness benefits, are covered with no copay, while other services like in-home safety assessments, medical nutrition therapy, and counseling services are not covered. Kidney disease education services, as well as glaucoma screenings, 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 Complete Platinum (HMO D-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $2000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. There is no copay for eye exams, and for eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, there is also no copay. The plan covers one routine eye exam and one pair of eyeglasses (lenses and frames) or eyeglass lenses every year, with a combined maximum amount of $400. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. Fluoride treatments, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs, and Medicare Part B Chemotherapy/Radiation Drugs with no copay. Other Medicare Part B Drugs also have no copay.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment, prosthetics, and diabetic equipment. Durable medical equipment has no coinsurance and no copay, but requires authorization and preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Lab Services have no copay, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Complete Platinum (HMO D-SNP) 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 Complete Platinum (HMO D-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Simply Complete Platinum (HMO D-SNP) plan, but the additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required.
Other Services See details
The Simply Complete Platinum (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $135.00 per month. Meal benefits are also covered with no copay, but require prior authorization and a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are 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.
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