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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 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 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 $0.00. 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) plan has an annual prescription drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacies or standard mail order services. For other medication categories, you will pay a 25% coinsurance. This 25% coinsurance applies to Tier 2 generic and Tier 3 preferred brand drugs for one, two, or three-month supplies, as well as one-month supplies of Tier 4 non-preferred drugs and Tier 5 specialty tier drugs.
Additional Benefits
The Simply Integrated Platinum (HMO D-SNP) plan offers highly affordable healthcare coverage, featuring no copays and no coinsurance for a wide range of essential services. This includes complete coverage for inpatient and outpatient hospital care, primary and specialist doctor visits, emergency services, and diagnostic testing. Members can access critical medical services and preventive care without worrying about out-of-pocket costs. In addition to medical care, this plan provides robust supplemental benefits designed to support overall wellness. Eligible members receive dental coverage up to a $1,500 annual maximum, a $400 yearly eyewear allowance, and prescription hearing aids with no copays. The plan also features valuable everyday extras, including unlimited transportation to plan-approved health locations, a $125 monthly over-the-counter allowance, and home safety modifications.
Inpatient Hospital See details
Simply Integrated Platinum (HMO D-SNP) provides coverage for inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although 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 Platinum (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization and referrals are required for most of these covered outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required for these services.
Ambulance and Transportation Services See details
Simply Integrated Platinum (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because it provides 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 Platinum (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with no copay and no 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, occupational therapy, mental health, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered, but other benefits like routine podiatry are covered for up to 12 visits per year with no copay and no coinsurance.
Preventive Services See details
Simply Integrated Platinum (HMO D-SNP) partially covers preventive services with no copays and no coinsurance for covered benefits, though several sub-services like annual physical exams and nutritional therapy are not covered. Covered benefits include Medicare-covered preventive care, glaucoma screenings, diabetes self-management training, and select supplemental services like a fitness program and home safety modifications up to $200 monthly.
Hearing Services See details
Hearing services are covered by Simply Integrated Platinum (HMO D-SNP) with no copays and no coinsurance for routine exams, fitting evaluations, and up to two prescription hearing aids with a $1,500 annual limit. This benefit is partially covered as over-the-counter, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Simply Integrated Platinum (HMO D-SNP) features partially covered vision services with no copay and no coinsurance, which includes one annual routine eye exam and a $400 yearly allowance for eyewear. Other eye exam services and eyewear upgrades are not covered by the plan.
Dental Services See details
Simply Integrated Platinum (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a $1,500 annual maximum, though prior authorization is required for Medicare and comprehensive services. Implant services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required and step therapy may apply. This fully covered benefit includes Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all of which feature no copays and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Simply Integrated Platinum (HMO D-SNP) plan 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 services, with no copay and no coinsurance. Prior authorization is required for these covered benefits, and certain brand or vendor limitations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are fully covered by Simply Integrated Platinum (HMO D-SNP) with no copays and no coinsurance for all diagnostic procedures, lab services, X-rays, and radiological treatments. Please note that prior authorization and referrals are required for these services.
Home Health Services See details
Home health services are covered under the Simply Integrated Platinum (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance. However, only some services are covered, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Simply Integrated Platinum (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance for the first 100 days, as additional days beyond the Medicare-covered limit are not covered. Referral and prior authorization are required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
Other Services are partially covered under the Simply Integrated Platinum (HMO D-SNP) plan, featuring no copay and no coinsurance for eligible benefits. Covered options include chronic illness meals and a $125 monthly allowance for over-the-counter (OTC) items, while acupuncture, Naloxone, and other 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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