A non-government entity
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 Highlands, Indian River, Martin, St Lucie. 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:
Sign up for Simply Complete Platinum (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Simply Complete Platinum (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members benefit from no copay on Tier 1 preferred generic drugs and Tier 6 supplemental drugs when using standard pharmacy or standard mail order services. For other drug tiers, the plan requires 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 drugs.
Additional Benefits
The Simply Complete Platinum (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for the vast majority of its medical services. Members can access inpatient and outpatient hospital care, primary and specialist visits, emergency services, and home health care without any out-of-pocket copays or coinsurance. However, a 20% coinsurance does apply to dialysis services and therapeutic radiological treatments. This plan also features robust supplemental benefits, including dental care and hearing aids up to a $1,500 annual maximum each, alongside a $400 annual eyewear allowance with no deductible. Additionally, members benefit from unlimited one-way transportation to plan-approved locations and a $129 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization and referrals are required. Specific sub-services such as additional days, non-Medicare-covered stays, and upgrades are not covered under this plan.
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 or referrals are required for some of these covered services.
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 this benefit.
Ambulance and Transportation Services See details
Simply Complete Platinum (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance, subject to prior authorization. The transportation benefit is partially covered, offering unlimited one-way rides to plan-approved health-related locations, 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 or coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Simply Complete Platinum (HMO D-SNP) provides primary care, specialist, therapy, telehealth, and mental health services with no copay and no coinsurance. Routine podiatry is covered for up to 12 visits per year with no copay or coinsurance, though chiropractic services are not covered.
Preventive Services See details
Simply Complete Platinum (HMO D-SNP) offers partially covered preventive services with no copays and no coinsurance for covered benefits. However, sub-services such as annual physical exams, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Simply Complete Platinum (HMO D-SNP) covers hearing exams and fitting evaluations with no copay and no coinsurance. Hearing aid benefits are partially covered with no copay or coinsurance up to a $1,500 annual maximum, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Simply Complete Platinum (HMO D-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits. Members receive one routine eye exam and a $400 annual combined maximum for eyewear like contact lenses and eyeglasses, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance, up to a maximum yearly benefit of $1,500. While preventive and most comprehensive dental care 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, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, insulin, and other Part B drugs are also provided with no copay and no coinsurance, though step therapy may apply.
Dialysis Services See details
Dialysis Services are covered under the Simply Complete Platinum (HMO D-SNP) plan 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 certain items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Simply Complete Platinum (HMO D-SNP) with no copays or coinsurance for lab services, diagnostic tests, and diagnostic radiological services. Outpatient X-rays feature no copay, therapeutic radiological services require a 20% coinsurance, and prior authorization and referrals are required for these services.
Home Health Services See details
Home health services are covered under Simply Complete Platinum (HMO D-SNP) with no copay and no coinsurance. Members must obtain prior authorization and a referral to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay and no coinsurance under Simply Complete Platinum (HMO D-SNP), but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Simply Complete 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 inpatient hospital stay is not required for admission, but additional days beyond the standard 100 days are not covered.
Other Services See details
Simply Complete Platinum (HMO D-SNP) partially covers other services, providing meal benefits for chronic illnesses and a $129 monthly allowance for over-the-counter items with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved