Medicare Advantage · HMO
Simply Healthcare Plans, Inc.
Plan year 2026

Simply Integrated (HMO D-SNP) H5471-131

4.5 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$4.80
+ your Part B premium
Max out-of-pocket
$500
in-network annual cap
Primary care
$0
per visit copay
Specialist
$0
per visit
Eligibility required for this D-SNP
You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
Integration status
HIDE
Integrated-care plan
CMS data identifies this as an Applicable Integrated Plan.
Common dual-eligibility labels

These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.

FBDE
Full Medicaid benefits in addition to Medicare.
QMB+
QMB help with Medicare costs plus full Medicaid benefits.
SLMB+
SLMB help with the Part B premium plus full Medicaid benefits.
QMB
Help with Medicare premiums and Medicare-covered cost sharing.
Check the Summary of Benefits or Evidence of Coverage for the exact Medicaid levels this plan accepts.
Could a Medicare Savings Program help?

Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:

  • QMB: $1,350 for one person or $1,824 for a married couple
  • SLMB: $1,616 for one person or $2,184 for a married couple
  • QI: $1,816 for one person or $2,455 for a married couple
Alaska, Hawaii, and some states use different limits or resource rules. Qualifying for an MSP does not by itself confirm eligibility for this D-SNP. Apply through your state Medicaid office.
Learn about QMB, SLMB, and QI
Extra benefits for members who qualify
  • Food and produce benefit
  • General supports for living
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$615
Inpatient hospital
$0
Inpatient mental health
$0
Outpatient surgery
$0
Emergency room
$0
Urgent care
$0

This plan is for people with Medicaid. What you pay depends on your Medicaid level: with QMB, your share of Medicare-covered services is covered; with full Medicaid benefits, your state may also cover Medicaid-covered services. Your state Medicaid office can confirm your level — or call us at 1-866-764-3312 (TTY 711) and a Licensed Medicare Advisor will help confirm it and discuss this plan's details with you. If you lose Medicaid eligibility, you may be billed the plan's cost sharing.

What's included, and what it's actually worth7 benefits included. Tap any card for the detail

Hearing

$2,000/yr hearing aid allowance
Hearing aid allowance$2,000/yr hearing aid allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Dental

$1,200/yr preventive dental allowance
Details$1,200/yr preventive dental allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

OTC allowance

$55/month OTC allowance
Prepaid card$55/month OTC allowance

Vision

$400/yr eyewear allowance
Eyewear allowance$400/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$0 copay
In-network$0 copay per visit
Inpatient Hospital$0
In-network$0
Outpatient Surgery$0 copay
In-network$0 copay per procedure
Mental Health$0
Inpatient psychiatric$0
Fitness$0 fitness benefit
TransportationNon-emergency transportation benefit
DetailsNon-emergency transportation benefit
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$0
Preferred Generic
Tier 2
25%
Generic
Tier 3
25%
Preferred Brand· after deductible
Tier 4
25%
Non-Pref Brand· after deductible
Tier 5
25%
Specialty· after deductible
Tier 6
$0
Tier 6· after deductible

Our take

Where this plan shines

This plan’s out-of-pocket maximum ($500) is among the lowest available.
See your primary doctor for $0.
The specialist copay ($0) is among the more affordable options.
Highly rated by CMS (4.5 stars).

Things to know before you enroll

Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Summary of Benefits (PDF)
Download the plan's official Summary of Benefits document
Evidence of Coverage (PDF)
Complete plan details and rules
Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame al (833)668-2294 (TTY: 711) para solicitar documentos en español

Plan questions

Common questions about Simply Integrated (HMO D-SNP)

What does Simply Integrated (HMO D-SNP) cover?

Simply Integrated (HMO D-SNP) is a Dual Eligible Special Needs Plan, a Medicare Advantage plan for people who have Medicare and a Medicaid category the plan accepts. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental ($1,200/yr preventive dental allowance), vision ($400/yr eyewear allowance), hearing ($2,000/yr hearing aid allowance), and over-the-counter (OTC) ($55/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Simply Integrated (HMO D-SNP) cost in 2026?

The published 2026 monthly plan premium for Simply Integrated (HMO D-SNP) is $4.80. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $615. The in-network medical out-of-pocket maximum is $500; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $0. Member costs can depend on the Medicaid category the plan accepts and verifies. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Simply Integrated (HMO D-SNP)?

CMS lists Simply Integrated (HMO D-SNP) as a HMO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Do I qualify for Simply Integrated (HMO D-SNP)?

Simply Integrated (HMO D-SNP) is listed in the current plan record as a D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.

Learn about Medicare Savings Programs

What extra benefits does Simply Integrated (HMO D-SNP) offer for dual-eligible members?

The current plan record for Simply Integrated (HMO D-SNP) lists dental ($1,200/yr preventive dental allowance), vision ($400/yr eyewear allowance), hearing ($2,000/yr hearing aid allowance), over-the-counter (OTC) ($55/month OTC allowance), and fitness ($0 fitness benefit). Member costs can depend on the Medicaid category the plan accepts and verifies. The record identifies Part D prescription drug coverage. Review the plan documents for benefit limits, eligibility rules, and how Medicare and Medicaid coverage work together.

When can I enroll in Simply Integrated (HMO D-SNP)?

Simply Integrated (HMO D-SNP) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a D-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Explore related plans

Browse the full 2026 Dual Eligible Special Needs Plan directory. This plan is offered in Florida. Plan availability can vary by county.

More Dual Eligible Special Needs Plan options

These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We do not offer every plan available in your area. Currently we represent a limited number of organizations which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are based on 2026 data and may change annually.

Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of plan-approved items. Unused amounts will expire at the end of the month or quarter.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The plan formulary, pharmacy network, and/or copays may change at any time. You will receive notice when necessary.

This spending allowance is a special supplemental program for members with specific health conditions. Qualifying conditions include diabetes mellitus, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, or chronic heart failure, among others. Some plans may require at least two conditions and other requirements apply. See the plan's Evidence of Coverage for details.

Even if you have a listed chronic condition, you may not receive the benefit. Coverage also depends on the plan's specific coverage criteria for the SSBCI.

If you use this program for rent or utilities, Housing and Urban Development (HUD) requires it to be reported as income if you seek assistance. Contact your local HUD office if you have questions.

To join a Dual Eligible Special Needs Plan (D-SNP), you must be entitled to Medicare Part A, enrolled in Medicare Part B, and receive full Medicaid benefits or assistance from your state. Eligibility requirements vary by state and may require further verification. Enrollment in the plan depends on contract renewal.

Membership in this plan depends on your continued Medicaid eligibility. If you lose your Medicaid eligibility, you may be disenrolled from this plan. Contact your state Medicaid office or 1-800-MEDICARE (TTY: 1-877-486-2048) for more information.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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Simply Integrated H5471-131 (HMO D-SNP) — 2026 Costs & Benefits