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Simply Extra Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Extra Platinum (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Extra Platinum (HMO) in 2026, please refer to our full plan details page.
Simply Extra Platinum (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in Tampa Area. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Extra 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 Extra 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 Extra 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. 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 $3200.00 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 Extra Platinum (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs at preferred, standard, and standard mail-order pharmacies. This makes managing common medications highly affordable and accessible for plan members. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $40 copay for a one-month supply. Tier 4 non-preferred drugs cost a $95 copay at preferred and standard mail-order pharmacies, or $100 at standard pharmacies for a one-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at all available pharmacies.
Additional Benefits
The Simply Extra Platinum (HMO) plan offers robust healthcare coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays have a $150 daily copay for the first five days and no copay thereafter. Emergency care is available with a $150 copay, which is waived if you are admitted within 24 hours, and urgent care has a $30 copay. Members benefit from dental, vision, and hearing services, featuring routine exams with no copay and annual allowances of up to $1,000 for dental care and prescription hearing aids. Durable medical equipment and dialysis services carry a 0% to 20% coinsurance with no copay. Additionally, the plan includes valuable extras like a $20 monthly over-the-counter allowance and up to 12 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Simply Extra Platinum (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Extra Platinum (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $25 copay for substance abuse sessions, and copays ranging from $0 to $200 for outpatient hospital and observation services. Referrals and prior authorizations are required for most of these outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Extra Platinum (HMO) with a $25.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Simply Extra Platinum (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Simply Extra Platinum (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with a $150 copay and no coinsurance.
Primary Care See details
Simply Extra Platinum (HMO) provides primary care, telehealth, and podiatry services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services are covered with a $25 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Simply Extra Platinum (HMO) partially covers preventive services with no copays and no coinsurance for covered care, including Medicare-covered preventive services, kidney disease education, glaucoma screenings, diabetes self-management, and memory fitness. However, an annual physical exam and several supplemental services—including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs—are not covered.
Hearing Services See details
Hearing services are covered by Simply Extra Platinum (HMO) with no copay and no coinsurance for routine exams, fitting evaluations, and Medicare-covered exams. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual maximum, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Simply Extra Platinum (HMO) partially covers vision services with no copay and no coinsurance, providing one routine eye exam per year and a $100 annual allowance for contacts, eyeglasses, lenses, and frames. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Extra Platinum (HMO) provides partially covered dental services with no copay and no coinsurance, up to a maximum annual benefit of $1,000. While preventive and most comprehensive services are covered, implant services and orthodontics are not covered, and prior authorization is required for some treatments.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Extra Platinum (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Simply Extra Platinum (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Extra Platinum (HMO) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Simply Extra Platinum (HMO) covers diagnostic and radiological services, though referrals and prior authorizations are required. Diagnostic services have no coinsurance, featuring no copay for lab services and a copay ranging from $0 to $200 for procedures and tests, while radiological services have no copay for X-rays and diagnostic imaging but require a minimum $25 copay and 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the Simply Extra Platinum (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Simply Extra Platinum (HMO) with no coinsurance, but some services are covered while cardiac rehabilitation ($25 copay), intensive cardiac rehabilitation ($25 copay), pulmonary rehabilitation ($20 copay), and SET for PAD services ($20 copay) are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Simply Extra Platinum (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply Extra Platinum (HMO), offering no copay and no coinsurance for chronic illness meal benefits and up to $20 monthly for over-the-counter items. Acupuncture and other additional services are not covered under this benefit.
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