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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 Broward, Palm Beach. 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 $164.90. 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) prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately with no deductible costs. For Tier 1 preferred generics and Tier 6 supplemental drugs, you will pay no copay for up to a three-month supply at standard or preferred pharmacies. Tier 2 generic medications require a $10 copay for a one-month supply at retail pharmacies, but you can receive them with no copay through standard mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply at both standard and preferred pharmacies. Tier 4 non-preferred drugs cost a $95 copay at preferred pharmacies and standard mail order, or a $100 copay at standard pharmacies. Finally, Tier 5 specialty medications require a 33% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Simply Extra Platinum (HMO) plan offers robust medical coverage with no copays for primary care visits, telehealth services, and home health care. For inpatient hospital stays, members pay a $200 copay for days 1 through 5 and no copay for days 6 through 90, all with no coinsurance. Outpatient services, emergency care, and specialist visits are also covered, typically requiring low copays and no coinsurance. This plan features excellent supplemental benefits, including no copays or coinsurance for routine dental, vision, and hearing services up to generous annual allowances. Members benefit from a $300 eyewear allowance, a $1,000 hearing aid benefit, and up to $1,200 in dental coverage. Additionally, diabetic supplies and routine transportation are covered with no copay, while durable medical equipment and dialysis require coinsurance up to 20%.
Inpatient Hospital See details
Simply Extra Platinum (HMO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $200 copay for days 1 through 5 and no copay for days 6 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Simply Extra Platinum (HMO) covers outpatient services with no coinsurance, offering a $0 to $200 copay for outpatient hospital services and a $200 copay per stay for observation services. Ambulatory surgical center and blood services have no copay, while individual and group outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Simply Extra Platinum (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
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. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Simply Extra Platinum (HMO) with a $150 copay, and urgently needed services are covered with a $25 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Extra Platinum (HMO) features primary care physician visits, telehealth benefits, and other healthcare professional services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, psychiatric services, and mental health sessions have a $20 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Simply Extra Platinum (HMO) plan, offering covered benefits like health education, memory fitness, and kidney disease education with no copays and no coinsurance. However, several services are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, and medical nutrition 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, and fitting evaluations. Prescription hearing aids are covered up to a $1,000 maximum annual benefit with no copay or coinsurance, though over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Simply Extra Platinum (HMO) vision services are covered with no copay, no coinsurance, and no deductible, including one annual routine eye exam and a $300 yearly allowance for eyewear. These benefits are partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Extra Platinum (HMO) with no copay and no coinsurance for covered services up to a $1,200 annual maximum. While preventive and comprehensive services like exams, cleanings, and restorative care are fully covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Extra Platinum (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Simply Extra Platinum (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Extra Platinum (HMO) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for Medicare-covered prosthetics and medical supplies. Diabetic equipment and supplies are covered with no copay and no coinsurance, though prior authorization is required for all medical equipment and some items are limited to preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Extra Platinum (HMO), requiring prior authorization and referrals. Diagnostic services feature no coinsurance, with no copay for lab tests and a $0 to $200 copay for procedures, while radiological services range from no copay for X-rays to a minimum $25 copay and 20% coinsurance for therapeutic services.
Home Health Services See details
Home health services are covered by Simply Extra Platinum (HMO) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Simply Extra Platinum (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, but specific sub-services—including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services—are not covered and require a $20 copay. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Simply Extra Platinum (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required, and while a prior three-day hospital stay is not needed, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Simply Extra Platinum (HMO) partially covers other services, providing a chronic illness meal benefit and over-the-counter items with no copay and no coinsurance. Acupuncture, Naloxone, and certain other services are not covered under this benefit.
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