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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 Select counties in Tampa Area. 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 drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when filled for a one-month, two-month, or three-month supply through standard pharmacies or standard mail order. For Tier 2 generic and Tier 3 preferred brand drugs, you are responsible for a 25% coinsurance across all supply durations. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty tier drugs require a 25% coinsurance for a one-month supply at standard pharmacies or standard mail order.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive healthcare coverage with no copay and no coinsurance for most major medical services. This includes complete coverage for inpatient hospital stays, outpatient services, primary care visits, and emergency care, including worldwide emergency coverage up to $100,000. Additionally, members can access diagnostic tests, medical equipment, and home health services with no out-of-pocket costs, though some services require prior authorization or referrals. This plan also features robust supplemental benefits, providing routine dental, vision, and hearing services with no copay and no coinsurance. Members receive generous allowances, including up to $1,200 annually for dental care, $400 for eyewear, $2,000 for prescription hearing aids, and a $55 monthly allowance for over-the-counter items. Unlimited one-way transportation to plan-approved health locations is also fully covered with no copay.
Inpatient Hospital See details
Simply Integrated (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. While prior authorization and referrals are required for most of these services, 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. Prior authorization and a referral are required to receive this care.
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. This benefit includes unlimited one-way trips to plan-approved health-related 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 care, and emergency transportation are also covered with no copay or coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Simply Integrated (HMO D-SNP) offers primary care, specialist visits, physical and occupational therapy, mental health, podiatry, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for covered services like kidney disease education, glaucoma screenings, diabetes self-management training, and memory fitness. However, several services are not covered under this plan, including the annual physical exam, medical nutrition therapy, in-home safety assessments, and weight management programs.
Hearing Services See details
Simply Integrated (HMO D-SNP) covers hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual maximum for both ears combined, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for annual routine eye exams and eyewear up to a $400 yearly 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, up to a maximum annual benefit of $1,200. Covered preventive and comprehensive services require no copay or coinsurance, though prior authorization is required for some, while implant services and orthodontics are not covered.
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 is required. This benefit includes Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all provided with no copays 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
Simply Integrated (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and no coinsurance. Prior authorization is required for these services, and some equipment and supplies are 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, and X-rays, with no copay and no coinsurance. Prior authorization and a referral are required for these covered services.
Home Health Services See details
Simply Integrated (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Simply Integrated (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Simply Integrated (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, though additional days beyond the Medicare-covered limit are not covered. Prior authorization and referrals are required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
Simply Integrated (HMO D-SNP) partially covers other services, providing a meal benefit for chronic illness and a $55 monthly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture, highly integrated services for dual eligibles, and other additional services are not covered.
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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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