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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 Orange, Osceola, Seminole, Volusia. 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 $4.80. 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) plan features an annual prescription drug deductible of $615. For cost savings, members pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacies or standard mail order. This ensures that many common and supplemental medications are available at no cost to you. For other medication tiers, the plan charges a consistent 25% coinsurance through standard pharmacies and standard mail order. This 25% coinsurance applies to Tier 2 generic and Tier 3 preferred brand drugs for up to a three-month supply. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care, specialist visits, inpatient hospital stays, and emergency services. Members can also access diagnostic tests, outpatient services, and skilled nursing facility care for up to 100 days at no cost, though some services require prior authorization or referrals. Additionally, the plan covers worldwide emergency care up to a $100,000 maximum benefit. For supplemental wellness, the plan provides dental, vision, and hearing coverage with no copays or coinsurance, including annual allowances of $1,200 for dental services, $350 for eyewear, and $1,500 for prescription hearing aids. Members also benefit from unlimited transportation to plan-approved locations, an $80 monthly allowance for over-the-counter items, and chronic illness meal benefits. These additional perks ensure robust support for your healthcare needs without the burden of out-of-pocket costs.
Inpatient Hospital See details
Simply Integrated (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, although 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 care, ambulatory surgical center visits, substance abuse therapy, and blood services, with no copay and no coinsurance. While some of these services require prior authorization or a referral, there is no deductible for outpatient blood services.
Partial Hospitalization See details
Simply Integrated (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Transportation benefits are partially covered, offering unlimited one-way rides via rideshare, van, medical transport, or public transit to plan-approved locations, while 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 or coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Integrated (HMO D-SNP) covers primary care, specialist visits, physical, occupational, and speech therapies, telehealth, and mental health services with no copay and no coinsurance. Routine podiatry is also covered with no copay and no coinsurance for up to 12 visits per year, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services are partially covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for eligible benefits such as Medicare-covered preventive care, kidney disease education, and select home safety devices. However, this plan does not cover annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, or counseling.
Hearing Services See details
Simply Integrated (HMO D-SNP) covers hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,500 annual maximum, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Simply Integrated (HMO D-SNP) offers partially covered vision services with no copay and no coinsurance, including one routine eye exam and up to a $350 annual allowance for eyewear like contact lenses and eyeglasses. 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, offering up to a $1,200 maximum annual benefit for other dental services. Preventive and most comprehensive services are covered, although prior authorization is required for some, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Integrated (HMO D-SNP) covers home infusion bundled services, including Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, with no copay and no coinsurance. Prior authorization is required for these services, and step therapy may apply.
Dialysis Services See details
Simply Integrated (HMO D-SNP) covers dialysis services with no copay and no coinsurance. This benefit ensures that eligible members receive necessary kidney dialysis treatments at no cost.
Medical Equipment See details
Simply Integrated (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and no coinsurance. Prior authorization is required for these benefits, and coverage 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 tests, therapeutic radiology, and outpatient X-rays, with no copay and no coinsurance. Prior authorization and referrals are required for these services.
Home Health Services See details
Simply Integrated (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply Integrated (HMO D-SNP) offers cardiac rehabilitation services with no copay and no coinsurance, meaning some services are covered, though standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization and a referral are required for these services.
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, though prior authorization and referrals are required. This plan allows for SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Simply Integrated (HMO D-SNP) covers select other services, offering a meal benefit for chronic illnesses and up to $80 monthly for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other additional services under this category are not covered.
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