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Simply Integrated Platinum (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Integrated Platinum (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 Platinum (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Integrated Platinum (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Integrated Platinum (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 Platinum (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 Platinum (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 Platinum (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 Platinum (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members enjoy 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 Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% cost-sharing rate applies to standard pharmacy and standard mail-order services during the initial coverage phase. Understanding these straightforward cost-sharing tiers helps you plan your healthcare budget effectively.
Additional Benefits
The Simply Integrated Platinum (HMO D-SNP) plan offers comprehensive healthcare coverage with no copays and no coinsurance for most essential services. Members can access inpatient hospital stays, outpatient care, primary and specialist visits, and emergency services with zero out-of-pocket costs for copayments or coinsurance. Additionally, the plan covers critical needs like medical equipment, home health, and skilled nursing facility care at no cost to the member, though prior authorization or referrals may be required. This plan also includes valuable supplemental benefits such as dental, vision, and hearing coverage with no copays or coinsurance, subject to specific annual limits. Members benefit from a $2,000 yearly allowance for prescription hearing aids, a $400 annual limit for eyewear, and up to $1,500 annually for comprehensive dental services. Furthermore, eligible members receive up to $132 monthly for over-the-counter items and unlimited one-way transportation to plan-approved health locations at no additional cost.
Inpatient Hospital See details
Simply Integrated Platinum (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance. Prior authorization and referrals are required, and additional days or non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Integrated Platinum (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copays and no coinsurance. Prior authorization and referrals are required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Simply Integrated Platinum (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 Platinum (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
Simply Integrated Platinum (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation services are also covered with no copay or coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Simply Integrated Platinum (HMO D-SNP) covers primary care, specialist visits, mental health, therapy, and podiatry services with no copay and no coinsurance. Chiropractic services are not covered in practice, as both routine and other chiropractic services are excluded.
Preventive Services See details
Simply Integrated Platinum (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Simply Integrated Platinum (HMO D-SNP) covers routine hearing exams and fitting evaluations annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 yearly limit, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, offering one routine eye exam and up to $400 yearly for eyewear like contacts or eyeglasses. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental Services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance for covered services, up to a $1,500 annual maximum for other dental services. Covered benefits include preventive care, oral exams, and surgeries, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Simply Integrated Platinum (HMO D-SNP) covers home infusion bundled services with no coinsurance, though prior authorization and step therapy are required. Related Medicare Part B drugs, including insulin, chemotherapy, and radiation treatments, are covered under this benefit with no copays and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
Simply Integrated Platinum (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 benefits, and certain items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Integrated Platinum (HMO D-SNP) with no copays and no coinsurance. Prior authorization and referrals are required for these services, which include diagnostic tests, lab work, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Simply Integrated Platinum (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Cardiac Rehabilitation Services See details
Simply Integrated Platinum (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Simply Integrated Platinum (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization and a referral are required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Integrated Platinum (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $132 monthly for OTC items, and the meal benefit is available for chronic or medical conditions requiring prior authorization and a referral.
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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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