A non-government entity
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 Broward. 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:
Sign up for Simply Integrated (HMO D-SNP)
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 Integrated (HMO D-SNP) medicare plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacies or standard mail-order services. This coverage applies to one-month, two-month, and three-month supplies. For Tier 2 generic and Tier 3 preferred brand drugs, you are responsible for a 25% coinsurance across all supply durations. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply. These cost-sharing terms apply to both standard pharmacy and standard mail-order options.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays and no coinsurance for almost all primary medical services. Members can access inpatient and outpatient hospital care, emergency services, primary and specialist visits, and preventive care at no out-of-pocket cost. This extensive coverage also extends to home health care, medical equipment, and diagnostic services, though prior authorizations are required for many of these benefits. In addition to core medical care, the plan provides valuable supplemental benefits including dental, vision, and hearing coverage with no copays or coinsurance, up to specified annual limits. Members also receive extra perks such as unlimited transportation to plan-approved locations and a monthly allowance for over-the-counter items. However, it is important to note that certain services, such as cardiac rehabilitation and chiropractic care, are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care through Simply Integrated (HMO D-SNP) is partially covered, providing Medicare-covered acute and psychiatric stays with no copay and no coinsurance. Prior authorization and referrals are required, and 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, substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these covered outpatient treatments.
Partial Hospitalization See details
Simply Integrated (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Simply Integrated (HMO D-SNP) with no copays and no coinsurance, subject to prior authorization. Transportation benefits are partially covered, offering unlimited one-way rides to plan-approved locations via rideshare, van, or public transit, though trips to any other health-related locations are 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 coverage, urgent care, and emergency transportation are also covered with no copay or coinsurance up to a maximum benefit limit of $100,000.
Primary Care See details
Simply Integrated (HMO D-SNP) offers primary care, specialist, telehealth, therapy, and mental health services with no copay and no coinsurance. Routine podiatry is also covered for up to 12 visits per year with no copay and no coinsurance, though chiropractic services are not covered under this plan.
Preventive Services See details
Simply Integrated (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for all covered benefits, which include Medicare-covered zero-dollar preventive services, kidney disease education, and select supplemental benefits like health education and memory fitness. Several services are not covered under this plan, including annual physical exams, medical nutrition therapy, in-home safety assessments, and weight management programs.
Hearing Services See details
Hearing services are partially covered under Simply Integrated (HMO D-SNP) with no copays, coinsurance, or deductibles for covered services, which include one annual routine exam, one fitting evaluation, and up to two prescription hearing aids per year up to a $2,000 limit. OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Simply Integrated (HMO D-SNP) partially covers vision services with no copayment or coinsurance, offering one routine eye exam per year and a $400 annual limit for eyewear like contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Integrated (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to a $1,500 maximum annual limit. Covered preventive and comprehensive services include cleanings, exams, and restorative care, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Integrated (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including insulin, chemotherapy, and radiation, are also provided with no copay and no coinsurance.
Dialysis Services See details
Simply Integrated (HMO D-SNP) covers dialysis services with no copay and no coinsurance. There are no out-of-pocket costs for covered dialysis treatments under this plan.
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 services, and 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 tests, therapeutic radiology, and X-rays, with no copay and no coinsurance. Prior authorization and referrals are required to receive these covered 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, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Simply Integrated (HMO D-SNP) plan. None of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Simply Integrated (HMO D-SNP) covers skilled nursing facility (SNF) care for days 1 through 100 with no copay and no coinsurance, requiring prior authorization and a referral. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard 100 days are not covered.
Other Services See details
Simply Integrated (HMO D-SNP) partially covers other services, providing a chronic illness meal benefit and a $55 monthly allowance for over-the-counter items with no copay and no coinsurance. Acupuncture, dual eligible highly integrated services, and other additional services are not covered.
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