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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 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 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) prescription drug plan features an annual drug deductible of $615. Enrollees benefit from having no copay for Tier 1 preferred generic drugs and Tier 6 supplemental drugs when filled at standard pharmacies or through standard mail order. For other medication categories, including generic, preferred brand, non-preferred, and specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to Tier 2 and Tier 3 drugs, as well as one-month supplies of Tier 4 and Tier 5 drugs through standard pharmacy and standard mail order channels.
Additional Benefits
The Simply Integrated Platinum (HMO D-SNP) offers comprehensive healthcare coverage with no copays, no coinsurance, and no deductibles for almost all covered services. Members can access inpatient and outpatient hospital stays, emergency care, primary and specialist visits, and medical equipment at no cost. However, please note that many of these medical services require prior authorization or referrals before you can receive care. In addition to medical care, this plan provides valuable supplemental benefits with no out-of-pocket costs up to specified limits. You will receive routine vision care with a $400 annual eyewear allowance, dental services up to a $1,500 yearly maximum, and hearing exams with a $1,500 annual limit for prescription hearing aids. The plan also covers unlimited transportation to plan-approved locations and provides a $128 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Simply Integrated Platinum (HMO D-SNP) covers Medicare-covered inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered because additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Simply Integrated Platinum (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and no coinsurance. Prior authorization and referrals are required for most of these 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. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
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 and no coinsurance for unlimited one-way trips to plan-approved locations, while 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 coverage, urgent care, and emergency transportation 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) offers primary care, specialist, therapy, and mental health services with no copay and no coinsurance. Chiropractic services are not covered, as both routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services are partially covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance for covered services like glaucoma screenings, kidney education, and memory fitness. However, several services are not covered, including annual physical exams, weight management, alternative therapies, therapeutic massage, in-home safety assessments, and nutritional benefits. Covered home and bathroom safety devices also feature no copay, up to a $100 monthly maximum benefit.
Hearing Services See details
Hearing services are partially covered by Simply Integrated Platinum (HMO D-SNP), offering routine exams, fitting evaluations, and up to two prescription hearing aids per year with no copay, no coinsurance, and no deductible. The plan provides a maximum benefit of $1,500 annually for prescription hearing aids, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision Services under the Simply Integrated Platinum (HMO D-SNP) plan are partially covered with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and a $400 annual combined allowance for contact lenses and eyeglasses, while upgrades and other eye exam services are not covered.
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. Covered services include cleanings, exams, and oral surgery (some requiring prior authorization), while implant services and orthodontics are not covered.
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, though prior authorization and step therapy are required. This benefit includes Medicare Part B chemotherapy, insulin, and other Part B drugs, all of which are provided with no copays or 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 supplies may be 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, X-rays, and therapeutic radiological procedures, with no copays and no coinsurance. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Simply Integrated Platinum (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Simply Integrated Platinum (HMO D-SNP) with no copay and no coinsurance, though referrals and prior authorization are required. In practice, 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) 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. While the plan allows admission without a prior three-day inpatient hospital stay, 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, offering chronic illness meal benefits and a monthly $128 over-the-counter allowance with no copay and no coinsurance. Acupuncture, naloxone, and certain other services are not covered under this benefit.
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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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