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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 2026, 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 2026.
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 $175.00. 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 $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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs across preferred, standard, and standard mail-order pharmacies. This plan offers excellent savings on everyday medications, allowing you to fill up to a three-month supply of these tiers at no cost. For Tier 3 preferred brand drugs, you will pay a $30 copay for a one-month supply and $90 for a three-month supply. Tier 4 non-preferred drugs require a $95 copay at preferred pharmacies and standard mail order, or a $100 copay at standard pharmacies for a one-month supply. Specialty medications under Tier 5 carry a 33% coinsurance for a one-month supply regardless of the pharmacy type you choose.
Additional Benefits
The Simply Level Platinum (HMO C-SNP) plan offers robust medical coverage, highlighting no copays and no coinsurance for primary care, specialist visits, preventive care, and home health services. For inpatient hospital stays, members pay a $50 daily copay for days 1 through 5 and no copay for days 6 through 90, while emergency room visits carry a $135 copay that is waived if admitted. Outpatient services and diagnostic tests are highly affordable, featuring no coinsurance and copays ranging from no copay up to $75. In addition to standard medical care, this plan provides generous supplemental benefits, including no copays or coinsurance for dental care up to a $1,500 annual limit and routine vision exams with a $400 eyewear allowance. Members also benefit from a $1,000 hearing aid allowance, up to 24 one-way transportation trips to plan-approved locations, and a $30 monthly over-the-counter item allowance. Essential medical equipment and dialysis services are covered with no copay and coinsurance up to 20 percent.
Inpatient Hospital See details
Inpatient hospital care is covered by Simply Level Platinum (HMO C-SNP) with no coinsurance, requiring a $50 daily copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. This benefit is partially covered because upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered, although three additional acute care days are provided with no copay.
Outpatient Services See details
Simply Level Platinum (HMO C-SNP) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services have copays ranging from $0 to $75, while outpatient substance abuse sessions require a $50 copay, all with no coinsurance.
Partial Hospitalization See details
Simply Level Platinum (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Simply Level Platinum (HMO C-SNP) covers ambulance services with a $150.00 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are partially covered with no copay and no coinsurance, offering up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Simply Level Platinum (HMO C-SNP) covers emergency services with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $135 copay and no coinsurance.
Primary Care See details
Simply Level Platinum (HMO C-SNP) provides primary care, specialist visits, mental health, psychiatric, podiatry, and telehealth services with no copay and no coinsurance, while chiropractic services are not covered. Physical, occupational, and speech therapies require a $15 copay and no coinsurance, and opioid treatment services have a $50 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for covered benefits, including Medicare-covered zero-dollar preventive care, kidney disease education, and select supplemental benefits. However, several services are not covered, such as annual physical exams, weight management programs, in-home safety assessments, and nutritional or dietary benefits.
Hearing Services See details
Simply Level Platinum (HMO C-SNP) covers hearing services with no copay and no coinsurance for Medicare-covered exams, routine exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual maximum, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Simply Level Platinum (HMO C-SNP) offers partially covered vision services with no copay and no coinsurance, including one routine eye exam per year and a $400 annual allowance for contact lenses and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for covered preventive and comprehensive care up to a $1,500 annual limit. While most diagnostic, preventive, and restorative services are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Level Platinum (HMO C-SNP) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Simply Level Platinum (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Simply Level Platinum (HMO C-SNP), featuring durable medical equipment (DME) with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Simply Level Platinum (HMO C-SNP) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays have no copay, while diagnostic procedures and tests have a copay ranging from $0 to $75, and diagnostic or therapeutic radiological services have copays starting at $0.
Home Health Services See details
Simply Level Platinum (HMO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Simply Level Platinum (HMO C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Simply Level Platinum (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required, but a prior three-day hospital stay is not necessary for admission.
Other Services See details
Simply Level Platinum (HMO C-SNP) partially covers other services, providing over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and the OTC benefit is limited to $30 per month.
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