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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 2025, 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 2025.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred and standard pharmacies, while non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Simply Extra Platinum (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and emergency services also have copays. Many services such as primary care, preventive services, vision, dental, and home health services are covered with no copay. This plan also includes coverage for hearing aids, medical equipment, and diagnostic services, with a mix of copays and coinsurance depending on the specific service. Additionally, the plan provides transportation services and covers some prescription drugs and home infusion services. However, some services such as cardiac rehabilitation and certain other specialized care options are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-5, there is a $200 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered by the Simply Extra Platinum (HMO) plan. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a $200 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply Extra Platinum (HMO) plan and requires prior authorization and a doctor referral. The copay for this benefit is $25.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $250 copay, and air ambulance services have 20% coinsurance. Transportation services have no copay, and transportation to a plan-approved health-related location is covered for up to 12 one-way trips per year using rideshare services, bus/subway, van, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Simply Extra Platinum (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services have a $25 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $120 copay.
Primary Care See details
The Simply Extra Platinum (HMO) plan covers primary care physician services and chiropractic services with no copay, but routine chiropractic care is not covered. Physician specialist services, mental health specialty services (individual and group sessions), psychiatric services (individual and group sessions), physical therapy, and speech-language pathology services have a $20 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero-dollar services, but annual physical exams are not covered. Additional preventive services, including Health Education, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, and Other Preventive Services like Glaucoma Screening and Diabetes Self-Management Training, are covered with no copay.
Hearing Services See details
The Simply Extra Platinum (HMO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a maximum benefit of $1,000 per year with no copay for 2 visits per year, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for eye exams and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $300 every year, while upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all with no copay. There is a $1,500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Simply Extra Platinum (HMO), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with no copay and 0-20% coinsurance. Prosthetics/Medical Supplies have no copay and a 20% coinsurance for Medicare-covered services, while Diabetic Equipment is covered with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $200, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay up to $25 and a coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Simply Extra Platinum (HMO) plan with no copay and no coinsurance. 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 Extra Platinum (HMO) plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Simply Extra Platinum (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $60.
Other Services See details
The Simply Extra Platinum (HMO) plan covers over-the-counter items and meal benefits with no copay. 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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