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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 Orange, Osceola, Seminole. 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 $170.00. 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 $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, allowing your prescription drug coverage to begin immediately. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs at preferred pharmacies, standard pharmacies, and through standard mail order. Tier 2 generic drugs are also highly affordable, costing a $10 copay for a one-month supply at retail pharmacies, or no copay when filled through standard mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard and preferred pharmacies. Tier 4 non-preferred drugs require a one-month copay of $95 at preferred pharmacies or $100 at standard pharmacies. Specialty medications in Tier 5 carry a 33% coinsurance for a one-month supply across preferred, standard, and standard mail order pharmacies.
Additional Benefits
The Simply Extra Platinum (HMO) plan offers robust coverage for everyday healthcare needs, featuring no copays and no coinsurance for primary care visits, preventive services, dental care up to a $1,000 annual limit, and routine vision and hearing exams. Specialist visits require a $20 copay, while physical therapy and urgent care services carry a $25 copay with no coinsurance. Additionally, members benefit from a $225 annual eyewear allowance and up to $1,000 yearly for prescription hearing aids with no copays. For emergency and hospital care, the plan features a $125 copay for emergency room visits and a $200 daily copay for the first five days of an inpatient hospital stay, after which there is no copay. Durable medical equipment and dialysis services require up to a 20% coinsurance with no copays, while home health services are covered with no copay or coinsurance. Ground ambulance services carry a $250 copay, and the plan also provides up to 12 one-way trips per year to approved health locations with no copay.
Inpatient Hospital See details
Simply Extra Platinum (HMO) inpatient hospital services are partially covered, offering acute and psychiatric stays with no coinsurance, a $200 copay per day for days 1 through 5, and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and psychiatric additional days are not covered, and both benefits require prior authorization and referrals.
Outpatient Services See details
Simply Extra Platinum (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which also feature no copay. Outpatient hospital services require a copay of $0 to $200 (including a $200 copay per stay for observation services), while outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Simply Extra Platinum (HMO) plan with a $25 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
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, both requiring prior authorization. Transportation services are partially covered with prior authorization, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Simply Extra Platinum (HMO) covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $125 copay and no coinsurance.
Primary Care See details
Simply Extra Platinum (HMO) offers primary care, telehealth, and routine podiatry services with no copay and no coinsurance, while specialist visits have a $20 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment therapies are covered with a $25 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Simply Extra Platinum (HMO) provides partial coverage for preventive services, offering eligible benefits like Medicare-covered preventive care, kidney disease education, glaucoma screenings, and health education with no copay and no coinsurance. However, several sub-services are not covered by the plan, including annual physical exams, in-home safety assessments, and nutritional therapy.
Hearing Services See details
Hearing services are partially covered by Simply Extra Platinum (HMO), featuring no copay and no coinsurance for Medicare-covered exams, annual routine exams, fitting evaluations, and prescription hearing aids up to a $1,000 yearly limit. However, OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Simply Extra Platinum (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible, although other eye exam services and eyewear upgrades are not covered. Covered benefits include one routine eye exam per year and up to a $225 annual allowance for contact lenses or one pair of eyeglasses, lenses, and frames.
Dental Services See details
Simply Extra Platinum (HMO) dental services are partially covered with no copay and no coinsurance, up to a $1,000 yearly maximum. Covered benefits include cleanings, exams, and restorative care, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Extra Platinum (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
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
Medical equipment is covered by the Simply Extra Platinum (HMO) with no copays for all categories, featuring 0% to 20% coinsurance for durable medical equipment (DME) and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment, including supplies and therapeutic shoes, is also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Simply Extra Platinum (HMO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copays for lab and outpatient X-ray services, and diagnostic test copays ranging from $0 to $200. Therapeutic radiological services require a minimum 20% coinsurance and a $25 copay, with referrals and prior authorizations required for all services.
Home Health Services See details
Home Health Services are covered by Simply Extra Platinum (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply Extra Platinum (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are not covered, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Simply Extra Platinum (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring 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
Simply Extra Platinum (HMO) partially covers other services, providing over-the-counter (OTC) items up to $30 monthly and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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