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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 Orange, Osceola, Seminole, Volusia. 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. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs. This no-copay coverage applies to one-month, two-month, and three-month supplies filled at standard retail pharmacies or through standard mail order. For Tier 2 generic and Tier 3 preferred brand drugs, standard retail and mail-order pharmacies charge a 25% coinsurance across all supply lengths. Tier 4 non-preferred drugs and Tier 5 specialty drugs also carry a 25% coinsurance, which applies to a one-month supply.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for most essential healthcare services. Members enjoy no copays for inpatient and outpatient hospital care, primary and specialist visits, emergency services, and preventive care. Additionally, key medical needs like home health, durable medical equipment, and skilled nursing facility stays are covered with no copay or coinsurance, though prior authorizations or referrals are required for many of these benefits. This plan also features valuable supplemental benefits, including dental, vision, and hearing coverage with no copays, alongside a monthly allowance of up to $122 for over-the-counter items. While most services feature no out-of-pocket costs, exceptions include dialysis and therapeutic radiological services, which require a 20% coinsurance. Unlimited transportation to plan-approved locations and worldwide emergency coverage up to $100,000 are also included to ensure peace of mind.
Inpatient Hospital See details
Simply Complete Platinum (HMO D-SNP) partially covers inpatient hospital benefits, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, and sub-services such as 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, substance abuse, and blood services, with no copay and no coinsurance. While there is no deductible, prior authorization and referrals are required for most of these 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) covers ground and air ambulance services with no copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for unlimited one-way rides to plan-approved locations, but trips to any health-related location are 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, urgent care, and emergency transportation services are also covered with no copay or coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Simply Complete Platinum (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and no coinsurance. Routine podiatry is also covered for up to 12 visits per year with no copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance for covered care like glaucoma screenings and fitness benefits. However, some services are not covered, including annual physical exams, medical nutrition therapy, in-home safety assessments, weight management, alternative therapies, and in-home support.
Hearing Services See details
Simply Complete Platinum (HMO D-SNP) covers hearing exams and prescription hearing aids with no copay and no coinsurance, including one routine exam and one fitting evaluation annually. Hearing aid benefits are partially covered up to a $1,500 annual maximum, but over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay, no coinsurance, and no deductible for one annual routine eye exam and eyewear up to a $400 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive care up to a $1,500 yearly maximum. While most diagnostic, restorative, and surgical services 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 copay and no coinsurance, though prior authorization and step therapy are required. This coverage includes Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all of which feature no copays and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Simply Complete Platinum (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these services, and coverage may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Simply Complete Platinum (HMO D-SNP) covers diagnostic procedures, lab services, diagnostic radiology, and outpatient X-rays with no copay and no coinsurance. Therapeutic radiological services are covered with a 20% coinsurance, and all of these services require prior authorization and a referral.
Home Health Services See details
Home health services are covered under the Simply Complete Platinum (HMO D-SNP) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Simply Complete Platinum (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, but prior authorization and referrals 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.
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. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply Complete Platinum (HMO D-SNP), which offers chronic illness meal benefits and up to $122 monthly for over-the-counter items with no copays and no coinsurance. Acupuncture is not covered under this plan.
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* 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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