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Simply More Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply More Platinum (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply More Platinum (HMO) in 2025, please refer to our full plan details page.
Simply More 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 More 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 More 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 More 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.
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 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 More Platinum (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred and standard pharmacies, while standard generic drugs have a $15 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still be responsible for some costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Simply More Platinum (HMO) plan offers comprehensive coverage with no copays for inpatient hospital stays, outpatient blood services, partial hospitalization, primary care, chiropractic services, hearing exams, vision services, dental services, home health services, and OTC items. Emergency services have a $120 copay, while urgently needed services have a $15 copay. This plan provides additional benefits, including coverage for ambulance and transportation services, with varying copays and coinsurance. Additionally, it covers a range of outpatient services, diagnostic and radiological services, and skilled nursing facility stays with copays or coinsurance. There is also a $65 monthly benefit for over-the-counter items, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Simply More Platinum (HMO) plan, including all outpatient hospital services with a copay between $0 and $100, observation services with a $100 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $50 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Simply More Platinum (HMO) plan, with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Simply More Platinum (HMO), including ground and air ambulance services, and transportation services to a plan-approved health-related location. Ground ambulance services have a $125 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
The Simply More Platinum (HMO) plan covers emergency services, urgently needed services, and worldwide emergency services. Emergency services and worldwide emergency coverage have a $120 copay, while urgently needed services have a $15 copay; there is no coinsurance for any of these services.
Primary Care See details
The Simply More Platinum (HMO) plan covers Primary Care services with no copay, and Chiropractic services with no copay, but routine care is not covered. Occupational Therapy Services have a $15 copay, while Physician Specialist Services have no copay. Mental Health Specialty Services and Psychiatric Services have a $15 copay for individual and group sessions. Podiatry Services, Additional Telehealth Benefits, and Other Health Care Professional services have no copay. Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, additional preventive services with a copay for some services, and kidney disease education services with no copay. The plan does not cover 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, telemonitoring services, and counseling services.
Hearing Services See details
The Simply More Platinum (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $2,000 per year, and OTC hearing aids are covered with a maximum benefit of $500 per year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Simply More Platinum (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a maximum plan benefit coverage of $400 per year.
Dental Services See details
Dental services are covered, including Medicare dental services with a $0 copay and other dental services. Oral exams, dental x-rays, and prophylaxis (cleaning) have no copay, while other diagnostic dental services, fluoride treatment, other preventive dental services, implant services and orthodontics are unlimited. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, oral and maxillofacial surgery, and other orthodontics have a $0 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35.00. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply More Platinum (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $100, Therapeutic Radiological Services have a copay of up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered 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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Simply More Platinum (HMO) plan, with prior authorization and a doctor referral required. There is no copay for days 1-20, and a $55 copay for days 21-100.
Other Services See details
Under the Simply More Platinum (HMO) plan, 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. Over-the-Counter (OTC) Items have no copay, and the plan offers a monthly benefit of $65 for OTC items, including nicotine replacement therapy. The Meal Benefit also has no copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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