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Simply Level Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level Platinum (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level Platinum (HMO C-SNP) in 2026, please refer to our full plan details page.
Simply Level Platinum (HMO C-SNP) is a HMO C-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 2026.
It's important to know that Simply Level Platinum (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level Platinum (HMO C-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 Level Platinum (HMO C-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 Level Platinum (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $185.00. 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 Level Platinum (HMO C-SNP) prescription drug plan features a $0 drug deductible, allowing your coverage to start immediately. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs across preferred pharmacies, standard pharmacies, and standard mail order services. This ensures that many common and supplemental medications are available to you at no cost. For brand-name and specialized medications, Tier 3 preferred brand drugs have a $20 copay for a one-month supply at preferred and standard pharmacies. Tier 4 non-preferred drugs carry a $65 copay at preferred pharmacies and standard mail order, or a $70 copay at standard pharmacies for a one-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply regardless of the pharmacy type you choose.
Additional Benefits
The Simply Level Platinum (HMO C-SNP) Medicare plan offers comprehensive coverage with no copays for primary care visits, telehealth services, routine podiatry, and home health care. For inpatient hospital stays, members pay a 200 dollar copay per day for days one through five and no copay for days six through ninety, with no coinsurance required. Specialist visits carry a 20 dollar copay, while emergency care has a 75 dollar copay and urgent care requires a 25 dollar copay, both featuring no coinsurance. This plan also features robust supplemental benefits, including no copays or coinsurance for routine dental, vision, and hearing exams, alongside annual allowances for eyewear, hearing aids, and dental care. Additionally, members can access up to twenty-four one-way transportation trips per year to approved locations and a thirty-five dollar monthly allowance for over-the-counter items with no copays. Most diagnostic services, such as lab tests and outpatient X-rays, also feature no copays and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Simply Level Platinum (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. Medicare-covered acute and psychiatric stays incur a $200 copay for days 1 through 5 and no copay for days 6 through 90, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Level Platinum (HMO C-SNP) outpatient services are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $200, while individual and group outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Simply Level Platinum (HMO C-SNP) 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, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Simply Level Platinum (HMO C-SNP) covers emergency services with a $75 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 plan benefit with a $75 copay and no coinsurance.
Primary Care See details
Simply Level Platinum (HMO C-SNP) covers primary care visits, telehealth, and routine podiatry with no copay and no coinsurance, while chiropractic services are not covered. Specialist visits have a $20 copay, therapy and mental health services have a $25 copay, and opioid treatment has a $50 copay, all with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for eligible benefits such as Medicare-covered preventive care, kidney disease education, and glaucoma screenings. However, several services are not covered under this plan, including annual physical exams, in-home safety assessments, and weight management programs.
Hearing Services See details
Hearing services are covered by Simply Level Platinum (HMO C-SNP) with no copays, no coinsurance, and no deductibles for routine exams, Medicare-covered exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual maximum, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for one annual routine eye exam and eyewear up to a $225 yearly limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Level Platinum (HMO C-SNP) partially covers dental services with no copay and no coinsurance, up to a maximum annual benefit of $1,500. While preventive, diagnostic, and restorative services are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Level Platinum (HMO C-SNP) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Simply Level Platinum (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level Platinum (HMO C-SNP) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. Coinsurance ranges from 0% to 20% for DME, is 20% for prosthetics and medical supplies, and features no coinsurance for diabetic equipment.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Simply Level Platinum (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures and tests carry a copay of $0 to $200, and other radiological services have copays starting at $0.
Home Health Services See details
Home Health Services are covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Simply Level Platinum (HMO C-SNP), as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered by the plan.
Skilled Nursing Facility (SNF) See details
Simply Level Platinum (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral, but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under Simply Level Platinum (HMO C-SNP), which provides chronic illness meal benefits and an over-the-counter (OTC) item allowance of $35 monthly with no copay and no coinsurance. Acupuncture, Naloxone, and certain other services are not covered under this benefit.
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