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Simply Level Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level Platinum (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level Platinum (HMO C-SNP) in 2025, please refer to our full plan details page.
Simply Level Platinum (HMO C-SNP) is a HMO C-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 Level Platinum (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level Platinum (HMO C-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 Level Platinum (HMO C-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 Level Platinum (HMO C-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. 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 Level Platinum (HMO C-SNP) plan has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs, and a $47 copay for standard generic drugs. Preferred brand drugs have a $95 copay at preferred pharmacies and a $100 copay at standard pharmacies. Non-preferred drugs have 33% coinsurance, and specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Simply Level Platinum (HMO C-SNP) plan provides comprehensive coverage, including inpatient hospital stays with a $50 copay for the first five days, and no copay for days 6-90, along with outpatient services with varying copays. The plan also covers ambulance services, emergency services, and a wide range of primary care services, all with no copay. Additional benefits include coverage for hearing, vision, and dental services, with no copay for many services. The plan also offers home health services with no copay, and covers medical equipment, diagnostic services, and other services, such as an over-the-counter item benefit.
Inpatient Hospital See details
The Simply Level Platinum (HMO C-SNP) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $50 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric stays are also covered, with a $50 copay for days 1-5 and no copay for days 6-90, but Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $50, observation services with a $50 copay, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient Substance Abuse Services and Outpatient Blood Services are also covered, with individual and group sessions for outpatient substance abuse having a $50 copay, and outpatient blood services having no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Level Platinum (HMO C-SNP) plan, with no copay required. Prior authorization and a doctor's referral are necessary to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Simply Level Platinum (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay, while Urgently Needed Services has no copay.
Primary Care See details
The Simply Level Platinum (HMO C-SNP) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational therapy services have a $15 copay, and physical therapy and speech-language pathology services have a $15 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Simply Level Platinum (HMO C-SNP) covers preventive services, including Medicare-covered zero-dollar preventive services with prior authorization and a doctor referral, with no copay; however, annual physical exams are not covered. Additional preventive services like Health Education, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Personal Emergency Response System (PERS) are covered with no copay. Other services like In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered. Kidney Disease Education Services are covered with no copay and a doctor referral. Other preventive services such as 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 Level Platinum (HMO C-SNP) plan covers hearing exams with no copay, as well as routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1000 per year, and no copay for all types of prescription hearing aids except for inner ear, outer ear, and over the ear hearing aids which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $400 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a $1,500 maximum per year. There is no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics.
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. 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 under the Simply Level Platinum (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. DME has a coinsurance between 0% and 20%, while durable medical equipment for use outside the home is not covered. 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
Under the Simply Level Platinum (HMO C-SNP) plan, diagnostic and radiological services are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $75, Therapeutic Radiological Services have a copay up to $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Level Platinum (HMO C-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 covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. There is no copay for days 1-20, and a $60 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other services include Over-the-Counter (OTC) Items and a Meal Benefit. OTC items have no copay, and the plan offers a maximum of $57.00 per month for OTC items. The meal benefit also has no copay. 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.
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