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Simply Integrated (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Integrated (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Integrated (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Integrated (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Integrated (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Integrated (HMO D-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 Integrated (HMO D-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 Integrated (HMO D-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.
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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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 Integrated (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This cost-free coverage is available for one-month, two-month, and three-month supplies. For Tier 2 generic and Tier 3 preferred brand drugs, members pay a 25% coinsurance at standard pharmacies and standard mail order for all supply lengths. A 25% coinsurance also applies to one-month supplies of Tier 4 non-preferred drugs and Tier 5 specialty drugs. This consistent cost-sharing structure helps you easily predict your out-of-pocket prescription costs.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays, no coinsurance, and no deductibles for most covered services. This includes complete coverage for inpatient and outpatient hospital stays, primary and specialist care, emergency services, and diagnostic testing. Additionally, members can access essential home health, skilled nursing facility care, and medical equipment at no out-of-pocket cost. The plan also features robust supplemental benefits, including dental care up to a $1,500 annual limit, vision care with a $400 eyewear allowance, and hearing services with a $2,000 annual maximum for hearing aids, all with no copay. Furthermore, members receive unlimited one-way transportation to plan-approved locations, an $80 monthly allowance for over-the-counter items, and home-delivered meals for chronic conditions.
Inpatient Hospital See details
Simply Integrated (HMO D-SNP) partially covers inpatient hospital services, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, but additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Simply Integrated (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services—with no copays and no coinsurance. Prior authorization and referrals are required for many of these covered outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Simply Integrated (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Simply Integrated (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance, though prior authorization is required. Ground and air ambulance services are covered, while transportation benefits are partially covered, offering unlimited one-way trips to plan-approved health-related locations but excluding trips to any health-related location.
Emergency Services See details
Simply Integrated (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Primary Care benefits under Simply Integrated (HMO D-SNP) feature no copays and no coinsurance for primary care visits, specialist services, therapy, mental health, and telehealth. While routine podiatry is covered for up to 12 visits per year with no copay or coinsurance, chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for covered care, such as kidney disease education and glaucoma screenings. Sub-services not covered include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Simply Integrated (HMO D-SNP) with no copay, no coinsurance, and no deductible for routine exams, fittings, and prescription hearing aids up to a $2,000 annual maximum. However, this benefit is only partially covered, as OTC hearing aids alongside inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Simply Integrated (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered services, which include one routine eye exam per year and up to $400 annually for eyewear. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Simply Integrated (HMO D-SNP), offering no copay and no coinsurance for preventive and comprehensive care up to a $1,500 annual maximum. While most services are covered at no cost, implant services and orthodontics are not covered, and prior authorization is required for comprehensive and Medicare-covered dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance, although prior authorization and step therapy may be required. This benefit includes Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all of which are covered with no copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these benefits, and coverage for certain equipment and supplies is limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Simply Integrated (HMO D-SNP) covers diagnostic and radiological services, including lab tests, X-rays, and therapeutic radiology, with no copay and no coinsurance. Prior authorization and referrals are required for these services.
Home Health Services See details
Home Health Services are covered under the Simply Integrated (HMO D-SNP) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance; however, in practice only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Simply Integrated (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization and referrals are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Integrated (HMO D-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. The OTC benefit includes up to $80 monthly for select items, and the meal benefit is available for chronic or homebound conditions with prior authorization and a referral, though acupuncture is not covered.
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* 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.
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