A non-government entity
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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $30.00. 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 $3850.00 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:
Sign up for Simply More Platinum (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply More Platinum (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. You will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Supplemental Drugs) prescriptions for up to a 3-month supply at preferred, standard, and standard mail-order pharmacies. For Tier 3 (Preferred Brand) drugs, copays start at $20 for a 1-month supply at both preferred and standard pharmacies. Tier 4 (Non-Preferred) drugs carry a 1-month copay of $75 to $80, while Tier 5 (Specialty) medications require a 33% coinsurance for a 1-month supply.
Additional Benefits
The Simply More Platinum (HMO) plan offers comprehensive medical coverage with many essential services available at no copay and no coinsurance, including inpatient hospital stays, primary care visits, and specialist consultations. Emergency care is available with a $150 copay, while urgent care services require a low $15 copay, with no coinsurance for either. Outpatient services and diagnostic tests are also highly affordable, featuring no coinsurance and low or no copays for most procedures. This plan also provides robust supplemental benefits to support your overall wellness, including routine dental, vision, and hearing care with no copays or coinsurance. Members can take advantage of a $1,200 annual dental allowance, up to $2,000 yearly for prescription hearing aids, and a $400 annual limit for eyewear. Additionally, the plan includes unlimited transportation to approved locations and a $45 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Simply More Platinum (HMO) partially covers inpatient hospital services, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by Simply More Platinum (HMO) with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $100 copay, observation services carry a $100 copay per stay, and outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply More Platinum (HMO) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Ambulance and Transportation Services See details
Simply More Platinum (HMO) covers ground ambulance services with a $125 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited rides to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Simply More Platinum (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Simply More Platinum (HMO) provides primary care, specialist, telehealth, and podiatry services with no copay and no coinsurance, though chiropractic services are not covered. Mental health, psychiatric, physical, occupational, and speech therapies require a $15 copay and no coinsurance, while opioid treatment has a $50 copay and no coinsurance.
Preventive Services See details
Simply More Platinum (HMO) preventive services are partially covered with no copays and no coinsurance for covered benefits like kidney disease education, glaucoma screenings, and memory fitness. Sub-services not covered under this plan include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Simply More Platinum (HMO) hearing services are partially covered with no copays and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are covered up to $2,000 annually for up to two devices with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Simply More Platinum (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Routine eye exams (one per year) and eyewear (including contact lenses and one pair of eyeglasses annually up to a $400 maximum) are covered, though other eye exam services and upgrades are not covered.
Dental Services See details
Simply More Platinum (HMO) features partially covered dental services with no copay and no coinsurance, up to a $1,200 maximum annual benefit. While preventive, diagnostic, and many comprehensive services are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply More Platinum (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Simply More Platinum (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Simply More Platinum (HMO) with no copays, though prior authorization is required. Durable medical equipment carries a coinsurance of 0% to 20%, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies and therapeutic shoes are available with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply More Platinum (HMO) with no coinsurance, requiring prior authorization and referrals. Lab and outpatient X-ray services have no copay, diagnostic procedures and tests have a copay between $0 and $100, and diagnostic and therapeutic radiological services have copays starting at $0.
Home Health Services See details
Simply More Platinum (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply More Platinum (HMO) provides coverage for some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Simply More Platinum (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $60 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Simply More Platinum (HMO) partially covers other services, offering a meal benefit for chronic illness and over-the-counter (OTC) items up to $45 monthly with no copay and no coinsurance. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved