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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 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 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) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when filled through standard pharmacies or standard mail order. This zero-cost coverage applies to one-month, two-month, and three-month supplies of these medications. For other drug tiers, the plan utilizes a coinsurance model. You will pay a 25% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs across one-month, two-month, and three-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays and no coinsurance for the majority of its key services. This includes inpatient and outpatient hospital care, emergency services, primary and specialist visits, and skilled nursing facility stays. While most of these medical services require prior authorizations and referrals, they allow members to receive essential care with zero out-of-pocket costs. The plan also features robust supplemental benefits, including dental, vision, hearing, and transportation services with no copays or coinsurance, though annual maximum allowances apply to eyewear, hearing aids, and dental care. Notably, dialysis and therapeutic radiological services are exceptions that require a twenty percent coinsurance. Additionally, members can benefit from covered over-the-counter items and unlimited one-way trips to plan-approved locations at no cost.
Inpatient Hospital See details
Simply Complete Platinum (HMO D-SNP) partially covers inpatient hospital services, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Complete Platinum (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services—with no copays and no coinsurance. Prior authorization and referrals are required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply Complete Platinum (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Simply Complete Platinum (HMO D-SNP) offers partially covered ambulance and transportation services with no copays and no coinsurance, although prior authorization is required. Ground and air ambulance services alongside unlimited one-way trips to plan-approved locations are covered at no cost, but 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 copay and no coinsurance. Worldwide emergency coverage, urgent care, and emergency transportation are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Complete Platinum (HMO D-SNP) provides primary care benefits with no copay and no coinsurance for services including primary care provider visits, specialist visits, physical therapy, and mental health services. However, this benefit is only partially covered, as routine and other chiropractic services are not covered.
Preventive Services See details
Simply Complete Platinum (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like diabetes self-management, glaucoma screenings, and select home safety devices. Sub-services that are not covered under this plan include annual physical exams, medical nutrition therapy, weight management programs, in-home safety assessments, nutritional or dietary benefits, and alternative therapies.
Hearing Services See details
Hearing services are covered by Simply Complete Platinum (HMO D-SNP) with no copays, no coinsurance, and no deductible, which includes one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are partially covered with a $2,000 annual maximum for up to two devices, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Simply Complete Platinum (HMO D-SNP) offers partially covered vision services with no copay and no coinsurance, although other eye exam services and eyewear upgrades are not covered. Covered benefits include one routine eye exam per year and up to a $400 annual allowance for eyewear, including contact lenses and one pair of eyeglasses.
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 benefit of $1,500. While preventive, diagnostic, and comprehensive treatments are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Complete Platinum (HMO D-SNP) with no coinsurance, although prior authorization and step therapy are required. This benefit includes Medicare Part B chemotherapy, insulin, and other Part B drugs, all of which are covered with no copay and no coinsurance.
Dialysis Services See details
Simply Complete Platinum (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, is covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required for these benefits, and certain manufacturer or vendor limitations may apply.
Diagnostic and Radiological Services See details
Simply Complete Platinum (HMO D-SNP) covers diagnostic and radiological services with no copay and no coinsurance for lab services, diagnostic tests, diagnostic radiology, and outpatient X-rays. Therapeutic radiological services require a 20% coinsurance, and all of these services require prior authorization and a referral.
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 these benefits.
Cardiac Rehabilitation Services See details
Simply Complete Platinum (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though referrals and prior authorization are required. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this benefit.
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, though prior authorization and a referral are required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Complete Platinum (HMO D-SNP) provides partially covered other services, which include over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization and a referral.
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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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