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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 Polk. 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) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. For Tier 3 preferred brand drugs, members pay a 25% coinsurance for a 1-month, 2-month, or 3-month supply. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays and no coinsurance for most primary medical services. Members can access inpatient and outpatient hospital care, emergency services, primary and specialist visits, and diagnostic testing at zero cost. Essential support services like home health care, durable medical equipment, and dialysis are also fully covered, though many services require prior authorization or referrals. In addition to core medical care, this plan provides valuable supplemental benefits with no copays, deductibles, or coinsurance. Members receive dental coverage up to $1,200 annually, vision care with a $400 eyewear limit, and hearing services with a $2,000 annual limit. The plan also features an $80 monthly allowance for over-the-counter items and unlimited transportation to plan-approved locations.
Inpatient Hospital See details
Simply Integrated (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Integrated (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these covered outpatient services.
Partial Hospitalization See details
Simply Integrated (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Simply Integrated (HMO D-SNP) covers ground and air ambulance services with no copay and no coinsurance, though prior authorization is required. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Simply Integrated (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Integrated (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered under this plan because routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services are partially covered by Simply Integrated (HMO D-SNP) with no copays and no coinsurance for all covered services, including Medicare-covered preventive care, kidney disease education, and select supplemental benefits like fitness and personal emergency response systems. However, several services are not covered under this plan, such as annual physical exams, weight management programs, and nutritional benefits.
Hearing Services See details
Simply Integrated (HMO D-SNP) offers hearing services with no copays, no coinsurance, and no deductibles for exams, fitting evaluations, and prescription hearing aids up to a $2,000 annual limit. This benefit is partially covered, as OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered under Simply Integrated (HMO D-SNP) with no copay, no coinsurance, and no deductible for routine eye exams and eyewear, which includes a $400 annual limit. 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) with no copay and no coinsurance for covered services, up to a maximum plan benefit of $1,200 per year. Covered care includes preventive, diagnostic, and major restorative services, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Simply Integrated (HMO D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. This benefit includes Medicare Part B chemotherapy, radiation, insulin, and other Part B drugs, all of which also feature no copays and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Simply Integrated (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Simply Integrated (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and no coinsurance. Prior authorization is required for these benefits, and coverage for some items may be 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 work, diagnostic procedures, therapeutic radiology, and X-rays, with no copays and no coinsurance. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home health services are covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Simply Integrated (HMO D-SNP) indicates some services are covered for 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 supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Simply Integrated (HMO D-SNP) for days 1 through 100 with no copay and no coinsurance, though prior authorization and referrals are required. While a three-day prior inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply Integrated (HMO D-SNP), which offers meal benefits and an $80 monthly over-the-counter allowance with no copay and no coinsurance. Acupuncture, Naloxone, and certain over-the-counter drugs are not covered under this plan.
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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.
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