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Simply Complete Platinum (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Complete 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 Complete Platinum (HMO D-SNP) in 2026, please refer to our full plan details page.
Simply Complete Platinum (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2026 to people living in Charlotte, Lee, Manatee, Sarasota. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Complete 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 Complete 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 Complete 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 Complete 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 Complete Platinum (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Under this plan, members pay no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs. This cost savings applies to one-month, two-month, and three-month supplies filled at standard retail 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. These coinsurance rates apply to fills at standard pharmacies as well as standard mail-order services.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) Medicare plan offers comprehensive healthcare coverage with no copays and no coinsurance for the vast majority of medical services. Members pay nothing out-of-pocket for inpatient hospital stays, primary and specialist visits, emergency care, and outpatient services. While most diagnostic tests and medical equipment also feature no copays, certain specialized treatments like dialysis and therapeutic radiology require a twenty percent coinsurance. In addition to medical care, the plan provides robust supplemental benefits including up to fifteen hundred dollars annually for dental services and a four hundred dollar yearly allowance for glasses or contacts with no copays. Members also benefit from no-cost transportation to approved health locations, a fifteen hundred dollar annual hearing aid benefit, and a one hundred twenty-eight dollar monthly allowance for over-the-counter items. Many of these services require prior authorization or referrals to ensure proper coordination of your care.
Inpatient Hospital See details
Simply Complete Platinum (HMO D-SNP) covers 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 upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Complete 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 covered benefits.
Partial Hospitalization See details
Simply Complete Platinum (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Ambulance and Transportation Services See details
Simply Complete 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, offering unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Simply Complete 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 and no coinsurance, up to a maximum plan benefit of $100,000.
Primary Care See details
Simply Complete Platinum (HMO D-SNP) features comprehensive primary care coverage with no copay and no coinsurance for primary care visits, specialist services, physical and occupational therapy, mental health services, and routine podiatry. Chiropractic services are not covered under this plan.
Preventive Services See details
Simply Complete Platinum (HMO D-SNP) provides partial coverage for preventive services with no copay and no coinsurance for covered benefits, such as Medicare-covered preventive care, glaucoma screenings, and select supplemental benefits like fitness programs and personal emergency response systems. However, several services are not covered, including annual physical exams, weight management programs, and medical nutrition therapy, and there is a $100 monthly limit on covered home and bathroom safety devices.
Hearing Services See details
Simply Complete Platinum (HMO D-SNP) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual maximum, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Simply Complete Platinum (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible. Eligible benefits include one routine eye exam per year and up to $400 annually for contacts or eyeglasses, while upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance, up to a maximum benefit of $1,500 every year. While preventive, restorative, and surgical services are covered, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance, although prior authorization and step therapy are required. This benefit includes Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs, all of which are available with no copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Simply Complete Platinum (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Complete 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 coverage may be limited to specified vendors or manufacturers.
Diagnostic and Radiological Services See details
Simply Complete Platinum (HMO D-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for these benefits. Members pay no copay and no coinsurance for diagnostic tests, lab work, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Simply Complete Platinum (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, specific options such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Simply Complete 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 referrals are required. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Simply Complete Platinum (HMO D-SNP), which offers a meal benefit for chronic illness and up to $128 per month for over-the-counter items with no copay and no coinsurance. Acupuncture, naloxone, and other sub-services are not covered under this plan.
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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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