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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 Lake, Marion, Sumter. 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) Medicare plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs. This $0 cost-sharing applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic and Tier 3 preferred brand drugs, members are responsible for a 25% coinsurance for one-month, two-month, and three-month supplies. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at standard retail or standard mail-order pharmacies.
Additional Benefits
The Simply Integrated Platinum (HMO D-SNP) offers comprehensive healthcare coverage with no copays and no coinsurance for almost all covered services, including inpatient hospital stays, primary care, specialist visits, and emergency care. Beneficiaries also receive full coverage with no out-of-pocket costs for essential services like dialysis, home health, diagnostic tests, and skilled nursing facility care. While most medical services require prior authorization or referrals, the plan ensures affordable access to critical care and worldwide emergency coverage up to $100,000. In addition to standard medical care, this plan provides valuable extra benefits with no copays, including up to $1,500 annually for dental care and $1,500 for prescription hearing aids. Members also benefit from a $400 annual eyewear allowance, unlimited one-way transportation to plan-approved locations, and a monthly allowance of $128 for over-the-counter health items. These additional allowances and zero-cost preventative services make it an attractive option for those seeking predictable healthcare expenses.
Inpatient Hospital See details
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. This benefit is partially covered as additional days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Simply Integrated Platinum (HMO D-SNP) covers outpatient services, including outpatient hospital care, ambulatory surgical center visits, outpatient substance abuse treatment, and outpatient blood services, with no copay and no coinsurance. 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, 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, subject to prior authorization. While ground and air ambulance services are fully covered, transportation services are partially covered, providing unlimited one-way rides to plan-approved locations but excluding transportation to any health-related location.
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 transportation services are also covered with no copay or coinsurance up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Integrated Platinum (HMO D-SNP) covers primary care, specialist visits, therapy, and mental health services with no copays and no coinsurance, though chiropractic services are not covered. Covered benefits, including telehealth and up to 12 routine podiatry visits per year, are fully covered with no copayment or coinsurance.
Preventive Services See details
Preventive Services are partially covered under the Simply Integrated Platinum (HMO D-SNP) plan, offering covered options like glaucoma screenings, fitness benefits, and kidney disease education with no copay and no coinsurance. However, several services are not covered under this plan, including annual physical exams, weight management programs, and nutritional or dietary benefits.
Hearing Services See details
Simply Integrated Platinum (HMO D-SNP) offers partially covered hearing services with no copay and no coinsurance for Medicare-covered exams, routine exams, and fittings. The plan provides up to $1,500 annually for up to two prescription hearing aids 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
Vision services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, providing one routine eye exam per year and a $400 annual allowance for eyewear like contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance for covered diagnostic, preventive, and comprehensive services up to a $1,500 annual maximum. Implant services and orthodontics are not covered under this plan, and prior authorization is required for Medicare-covered and comprehensive dental care.
Home Infusion bundled Services See details
Simply Integrated Platinum (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required and step therapy may apply. Covered bundle services include Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all of which feature no copays and no coinsurance.
Dialysis Services See details
Simply Integrated Platinum (HMO D-SNP) covers dialysis services with no copay and no coinsurance. This ensures you can receive necessary dialysis treatments with zero out-of-pocket costs.
Medical Equipment See details
Simply Integrated Platinum (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and no coinsurance. Prior authorization is required, and coverage for certain equipment and diabetic supplies is limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Simply Integrated Platinum (HMO D-SNP) covers diagnostic and radiological services, including lab work, tests, and X-rays, with no copay and no coinsurance. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home health services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Simply Integrated Platinum (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, 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) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, requiring prior authorization and a referral. This benefit does not require a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Simply Integrated Platinum (HMO D-SNP) partially covers other services, providing a meal benefit for chronic illnesses and up to $128 monthly for over-the-counter items with no copay and no coinsurance. Acupuncture, highly integrated services, and other additional 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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