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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 2025, 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 Orange, Osceola, Seminole. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $0.00. 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 $590.00 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) plan has an enhanced alternative drug benefit. The plan includes a $590 deductible for prescription drugs. After the deductible, you will pay 25% coinsurance for most drugs, with the exception of specialty tier drugs, which have no copay. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient services, primary care, preventive services, hearing, vision, dental, and home health services. Additionally, the plan provides coverage for ambulance, emergency services, medical equipment, and diagnostic services, all with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered with no copay. Additional days, and non-Medicare covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay. Individual and group sessions for Outpatient Substance Abuse have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Simply Complete Platinum (HMO D-SNP) plan, with no copay required. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with no coinsurance. Ground and air ambulance services have no copay. Transportation Services to a plan-approved health-related location are covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Simply Complete Platinum (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit of $100,000. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Simply Complete Platinum (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, which require prior authorization and a doctor referral, as well as additional preventive services with no copay. Annual physical exams, in-home safety assessments, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered. Other services such as health education, personal emergency response system (PERS), fitness benefits, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, 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
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1500 per year, and Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, have no copay, with a combined maximum benefit of $400 per year; however, upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. However, fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Simply Complete Platinum (HMO D-SNP) plan, with a $0 copay for Medicare Part B Insulin Drugs, and a $0 copay for Medicare Part B Chemotherapy/Radiation Drugs, and a $0 copay for Other Medicare Part B Drugs. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Simply Complete Platinum (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
The Simply Complete Platinum (HMO D-SNP) plan covers medical equipment, including durable medical equipment with no coinsurance and no copay, and requires prior authorization, as well as prosthetic devices and medical supplies with no coinsurance and no copay. This plan also covers diabetic equipment, including diabetic supplies and therapeutic shoes/inserts with no coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Simply Complete Platinum (HMO D-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Simply Complete Platinum (HMO D-SNP) plan. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Simply Complete Platinum (HMO D-SNP) plan and require prior authorization and a doctor's referral. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Simply Complete Platinum (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and also covers a Meal Benefit with no copay; however, 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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