Simply Extra (HMO)
Simply Extra (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Simply Healthcare
Plan ID: H5471-112
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Simply Extra (HMO) - H5471-112 by Simply Healthcare as well as other Medicare Advantage plans available in your area.
Simply Extra (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Simply Healthcare
Plan ID: H5471-112
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Simply Extra (HMO) - H5471-112 by Simply Healthcare as well as other Medicare Advantage plans available in your area.
Florida Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $3450 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: $0.00 copay |
| Specialty Doctor Visit | In-Network: $35.00 copay |
| Inpatient Hospital Care | In-Network: Days 1-5: $325.00 per day / Days 6-90: $0.00 per day |
| Urgent Care | Urgent Care: $40.00 copay Urgently Needed Services Copay Waived with Inpatient Admission |
| Emergency Room Visit | Emergency Care: $135.00 copay Copay waived if admitted to hospital within 24 hours Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000 per year. |
| Ambulance Transportation | Ground Ambulance: $250.00 copay Per Trip Air Ambulance: 20% coinsurance |
Health Care Services and Medical Supplies
Simply Extra (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Medicare Covered Chiropractic Services: $20.00 copay |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: $0.00 copay |
| Durable Medical Eqipment (DME) | In-Network: 0% - 20% coinsurance depending on the equipment |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay X-Rays: $0.00 copay - $100.00 copay Therapeutic Radiological Services: $40.00 copay - 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - $200.00 copay Diagnostic Radiological Services: $0.00 copay - $200.00 copay |
| Home Health Care | In-Network: $0.00 copay |
| Mental Health Inpatient Care | In-Network: Days 1-5: $325.00 per day / Days 6-90: $0.00 per day |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $40.00 copay |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $200.00 copay Observation Services: $200.00 copay Ambulatory Surgical Center: $100.00 copay |
| Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $40.00 copay |
| Over-the-counter (OTC) Items | This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $75 every month. Unused OTC amounts expire at the end of each month. |
| Podiatry Services | In-Network: Medicare Covered Podiatry Services: $0.00 copay Routine Foot Care: $0.00 copay 3 routine foot care visit(s) each year. |
| Skilled Nursing Facility Care | In-Network: Days 1 - 20: $0.00 per day / Days 21 - 100: $196.00 per day |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Preventive Dental Services: $0.00 copay Medicare Covered Dental: $0.00 copay Comprehensive Dental Services: $0.00 copay This plan covers up to a $1,000 allowance for covered preventive and comprehensive dental services every year. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay This plan covers up to $200 for eyeglasses or contact lenses every year. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Medicare Covered Hearing Exam: $0.00 copay Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. This plan covers 1 routine hearing aid fitting evaluation and a $1,000 maximum plan benefit for prescribed hearing aids every year. |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services |
