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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 Clay, Duval, St Johns. 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. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs filled through standard pharmacies or standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supply options. For Tier 2 generic and Tier 3 preferred brand medications, the plan requires a 25% coinsurance for all supply durations. Tier 4 non-preferred drugs and Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply. These coinsurance rates apply at both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Simply Integrated (HMO D-SNP) plan offers comprehensive healthcare coverage featuring no copays, no deductibles, and no coinsurance for almost all of its covered services. This includes full coverage for inpatient and outpatient hospital care, emergency and worldwide urgent services, and routine primary or specialist doctor visits. While essential medical services like home health and skilled nursing are covered at no cost, beneficiaries should note that many of these benefits require prior authorization and referrals. Beyond standard medical care, members enjoy robust supplemental benefits at no cost, including a $1,500 annual dental limit, a $400 eyewear allowance, and up to $2,000 yearly for prescription hearing aids. The plan also features a $107 monthly allowance for over-the-counter items and unlimited one-way transportation to plan-approved locations. However, certain services such as cardiac rehabilitation and acupuncture are not covered under this plan.
Inpatient Hospital See details
Simply Integrated (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization and referrals are required. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Simply Integrated (HMO D-SNP) covers outpatient services with no copay and no coinsurance, including outpatient hospital care, observation services, ambulatory surgical center visits, outpatient substance abuse treatment, and outpatient blood services. Prior authorization and referrals are required for most of these covered services.
Partial Hospitalization See details
Simply Integrated (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, though a referral and prior authorization are required for care.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Simply Integrated (HMO D-SNP) with no copays and no coinsurance, though prior authorization is required. Ground and air ambulance services are covered, and members receive unlimited one-way transportation to plan-approved locations, though 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. This benefit also includes worldwide emergency, urgent, and transportation services up to a $100,000 maximum limit, all with no copays or coinsurance.
Primary Care See details
Simply Integrated (HMO D-SNP) offers primary care, specialist, mental health, and therapy services with no copay and no coinsurance. Although chiropractic services are not covered in practice, the plan provides up to 12 routine podiatry visits per year with no copay or coinsurance.
Preventive Services See details
Simply Integrated (HMO D-SNP) offers partially covered preventive services with no copays and no coinsurance for covered benefits, including kidney disease education, glaucoma screenings, health education, and memory fitness. However, several sub-services are not covered, such as annual physical exams, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Simply Integrated (HMO D-SNP) with no copay, no coinsurance, and no deductible for Medicare-covered exams, routine exams, and hearing aid fittings. Prescription hearing aids are covered up to a $2,000 annual maximum with no copay or coinsurance, though over-the-counter (OTC) hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Simply Integrated (HMO D-SNP) partially covers vision services with no copay and no coinsurance, though other eye exam services and upgrades are not covered. Beneficiaries receive one routine eye exam per year and a $400 annual combined maximum allowance for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Simply Integrated (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to a maximum benefit of $1,500 per year. Covered preventive and comprehensive services require no copay and no coinsurance, though 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, although prior authorization is required. Covered drugs under this benefit, including Medicare Part B insulin, chemotherapy, and radiation drugs, 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 medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and no coinsurance. Prior authorization is required for these covered benefits, and certain items may be limited to specified manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Simply Integrated (HMO D-SNP) covers diagnostic and radiological services, including lab tests, therapeutic radiology, and outpatient X-rays, with no copay and no coinsurance. These covered services require prior authorization and a referral.
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 receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Simply Integrated (HMO D-SNP) plan, as intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded. While the plan technically lists these services with no copay and no coinsurance, they 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, requiring no prior three-day inpatient hospital stay. Prior authorization and referrals are required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Simply Integrated (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items up to $107 monthly and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone, and other miscellaneous services are not covered under this benefit.
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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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