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 Broward, Palm Beach. 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.
Below are a few key facts and commonly-asked questions about Simply Integrated Platinum (HMO D-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
The Simply Integrated Platinum (HMO D-SNP) Medicare 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 for one, two, or three-month supplies through standard pharmacies or standard mail order. This makes accessing essential everyday medications highly affordable. For Tier 2 generic and Tier 3 preferred brand drugs, the plan requires a 25% coinsurance for all supply lengths up to three months. Tier 4 non-preferred drugs and Tier 5 specialty drugs also carry a 25% coinsurance, which applies to a one-month supply at standard pharmacy and standard mail order locations.
The Simply Integrated Platinum (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for most essential healthcare services. This includes full coverage for inpatient and outpatient hospital stays, emergency care with worldwide coverage up to $100,000, primary and specialist doctor visits, and skilled nursing facility care. Additionally, members benefit from covered medical equipment, diagnostic services, and unlimited one-way transportation to plan-approved health locations with no out-of-pocket costs. This plan also features valuable supplemental benefits, including dental services up to a $1,500 annual limit and vision coverage with a $400 annual eyewear allowance. Members also receive prescription hearing aids covered up to $2,000 annually, alongside a $115 monthly over-the-counter allowance and chronic illness meal benefits, all with no copays or coinsurance. While many of these benefits require prior authorization or referrals, they offer substantial savings for eligible members.
Simply Integrated Platinum (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. Additional hospital days, room upgrades, and non-Medicare-covered stays are not covered under this benefit.
Simply Integrated Platinum (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 services.
Partial hospitalization is covered under the Simply Integrated Platinum (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Simply Integrated Platinum (HMO D-SNP) covers ground and air ambulance services with no copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for unlimited one-way trips to plan-approved health-related locations, though transportation to any health-related location is not covered.
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.
Simply Integrated Platinum (HMO D-SNP) covers primary care, specialist, therapy, mental health, and podiatry services with no copay and no coinsurance. Chiropractic services are not covered under this plan.
Preventive services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance for covered options like kidney disease education, fitness benefits, and health education. However, the plan does not cover an annual physical exam, in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, or counseling.
Hearing services are partially covered by Simply Integrated Platinum (HMO D-SNP), featuring no copays and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids. While prescription hearing aids are covered up to $2,000 annually, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Simply Integrated Platinum (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits. The plan includes one routine eye exam per year and up to a $400 annual limit for eyewear like contacts, eyeglasses, lenses, and frames, though other eye exam services and eyewear upgrades are not covered.
Dental Services are partially covered by Simply Integrated Platinum (HMO D-SNP), featuring no copay and no coinsurance for covered preventive and comprehensive services up to a $1,500 annual maximum. Prior authorization is required for several comprehensive treatments, and implant services and orthodontics are not covered.
Home Infusion bundled services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, including coverage for Medicare Part B insulin, chemotherapy, and other Part B drugs. Prior authorization is required for these services, and step therapy may apply.
Dialysis services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance.
Simply Integrated Platinum (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, with no copay and no coinsurance. Prior authorization is required for these covered benefits, and some equipment may be limited to specified manufacturers or preferred vendors.
Diagnostic and radiological services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization and referrals are required for these outpatient diagnostic procedures, lab tests, and radiological services.
Home health services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac rehabilitation services are not covered under the Simply Integrated Platinum (HMO D-SNP) plan, which excludes coverage for intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, although prior authorization and referrals are required. A prior three-day hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Simply Integrated Platinum (HMO D-SNP) provides partial coverage for other services, including a $115 monthly over-the-counter allowance and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, naloxone, and other select services are not covered under this plan.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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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.
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