Simply Healthcare Medicare Advantage Plans
For Medicare beneficiaries in Florida, Simply Healthcare Medicare Advantage plans offer comprehensive care through HMO and PPO options, with extra perks not found in Original Medicare.
This article cuts through the jargon to detail what these plans include, how they work, their costs, and what newcomers need to know to make an informed decision. Discover the simplicity of choosing a healthcare plan tailored to your lifestyle and medical needs without the sales pitch.
Key Takeaways
- Simply Healthcare offers a range of Medicare Advantage Plans in 2025, including HMO and PPO options, with benefits that can exceed those provided by Original Medicare, including prescription drugs, dental, vision, and wellness services.
- Enrollment in Simply Healthcare plans requires eligibility through Medicare Part A and B, with an annual open enrollment period from October 15th to December 7th, and Special Enrollment Periods available for qualifying individuals.
- Simply Healthcare Medicare Advantage Plans are available exclusively in Florida, covering a variety of conditions and offering extras like dental, vision, hearing, and fitness benefits, with further support through specialized networks and programs for managing chronic conditions.
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Discovering Simply Healthcare Medicare Advantage Plans
Simply Healthcare Medicare Advantage Plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans that offer coverage for Medicare beneficiaries in Florida.
The services provided by Simply Healthcare range from Medicare-contracted coordinated care plans to a Medicaid contract with the State of Florida Agency for Health Care.
The company also provides a wide range of plan options, ensuring there’s a suitable solution for everyone.
Understanding Medicare Advantage Basics
Medicare Advantage is a health plan provided by private companies, like Simply Healthcare, under contract with Medicare. These plans offer coverage for all Original Medicare services, and some may also offer additional benefits such as:
- Prescription drugs
- Vision
- Hearing
- Dental
- Wellness services
So, not only do you get everything Original Medicare provides, but you also get added benefits.
Still, the cost structure of Medicare Advantage plans in 2025 can differ depending on factors like the insurer and plan level. On average, the monthly premium is around $18 to $18.50. This means that while you’re getting more benefits, you’re not necessarily paying significantly more for them.
Navigating Simply Healthcare Plan Options
Simply Healthcare offers you a wide range of Medicare Advantage plans, including:
- Florida Managed Medical Assistance (Medicaid)
- Long-Term Care
- Florida Healthy Kids plans
This variety means you have the flexibility to choose a plan that best suits your healthcare needs.
However, selecting the appropriate plan requires thoughtful consideration. You need to take into account the coverage for dental, vision, and hearing services, additional benefits such as membership to fitness programs, and the overall cost. The cost can vary from plans with a $0 monthly premium to plans with an average cost of $15 per month.
You can make use of resources like Simply Medicare, complete a brief survey on their website to receive personalized care recommendations, and seek guidance from their extensive network of affiliated doctors for convenient access to medical care.
The Enrollment Process
Registration for a Simply Healthcare Medicare Advantage Plan requires individuals to meet the following eligibility criteria:
- Being entitled to Medicare Part A
- Providing essential documents including proof of identity, residency, income, and citizenship or immigration status
You should verify that you meet these criteria to prevent any obstacles during your enrollment process.
The open enrollment period for Medicare Advantage Plans, such as those offered by Simply Healthcare, starts on October 15th, and concludes on December 7th annually.
However, individuals who qualify for a Special Enrollment Period can enroll in a Simply Healthcare plan even after the standard open enrollment period has ended. This allows flexibility for those with specific circumstances that may affect their ability to enroll within the standard period.
Customizing Your Coverage with Simply Healthcare
Simply Healthcare extends beyond the basics of Original Medicare by offering extra benefits that cater to a broader range of healthcare needs.
Some of the additional benefits offered by Simply Healthcare include:
- Vision coverage
- Dental coverage
- Fitness benefits
- Telehealth visits
With Simply Healthcare, you can have peace of mind knowing that your healthcare needs are covered.
Benefits Beyond Original Medicare
One of the key features of Simply Healthcare’s Medicare Advantage plans is the inclusion of dental coverage. This offers care for a range of dental needs that go beyond what Original Medicare provides.
So, whether you need:
- a routine check-up
- a dental cleaning
- a filling
- a tooth extraction
- a root canal
- dentures
- braces
- or more complex dental work
Simply Healthcare has got you covered.
Along with dental coverage, Simply Healthcare also offers vision and hearing coverage. This means members have access to eye exams and other vision-related services, as well as comprehensive hearing coverage that includes hearing tests, hearing aids, and exams for diagnosing and treating hearing issues.
In essence, Simply Healthcare’s Medicare Advantage plans cover far more than just your basic health needs.
Prescription Drug Benefits Explained
Another significant benefit included in Simply Healthcare plans is prescription drug coverage. The coverage typically includes drugs listed in their formulary, provided the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are adhered to.
This is a significant advantage over Original Medicare, which does not include prescription drug coverage.
Simply Healthcare’s prescription drug benefits can deliver substantial savings for plan members.
The benefits include:
- Coverage for formulary drugs
- An extra $25 per family per month for over-the-counter items
- Assistance with drug costs through programs like Medicare Savings Programs
- Cost controls such as utilization management
- Savings through their over-the-counter Drug Catalog Program
- Minimal copayments for prescriptions covered under the Medicare Part D drug benefit.
Access to Specialized Networks
Specialized networks in healthcare refer to support networks that provide benefits to both patients and healthcare providers.
Simply Healthcare can provide access to specialized networks through their Medicare Advantage Special Needs Plans (SNPs) and integrated Medicare Advantage Prescription Drug (MA-PD) plans. This allows for a more personalized and effective healthcare experience.
These specialized networks include services that cover:
- Dental
- Vision
- Hearing
- Prescription drugs
- Additional benefits such as meal deliveries and transportation
They also offer specialty plans tailored to address the specific health requirements of their members.
These networks enhance the healthcare experience by coordinating care and enhancing the quality of healthcare, making Simply Healthcare a comprehensive healthcare solution.
Comparing Simply Healthcare Plans: Find Your Best Fit
Selecting the appropriate plan requires the correct tools. With a coverage comparison checklist, access to ratings and reviews, and expert advice, you can find the Simply Healthcare plan that best fits your needs.
Coverage Comparison Checklist
Simply Healthcare Medicare Advantage Plans provide comprehensive coverage, including:
- Medicare Part A and Part B
- Prescription drug coverage
- Dental coverage
- Vision coverage
- Hearing coverage
- Telehealth services
To compare the different Simply Healthcare Medicare Advantage plans in Florida, you can visit their website. This allows you to see at a glance which plans offer the coverage you need.
Yet, when choosing a Medicare plan, a checklist alone is insufficient. You should also assess:
- The plan structure (HMO vs. PPO)
- Incorporated benefits like health insurance and drug benefits
- Medicare Star Ratings
- If the plan provides hospital, medical, and prescription drug coverage in a single package
This ensures you are not just looking at the cost of the plan, but also the value it provides.
Ratings and Reviews
Ratings and reviews can provide valuable insights into the quality of a healthcare plan.
Simply Healthcare Medicare Advantage Plans have received a 4-star rating from CMS, and they have demonstrated improvement by achieving a 4.5-star rating compared to the previous year. This shows their commitment to providing high-quality healthcare solutions.
However, it’s also important to consider customer feedback. While Simply Healthcare has garnered some negative reviews, particularly related to customer service issues, it’s important to remember that these experiences are subjective and can differ based on individual circumstances.
By considering both ratings and reviews, you can get a more complete picture of what to expect from Simply Healthcare.
Help from Experts
Navigating the healthcare landscape can be complex, but you don’t have to do it alone. Simply Healthcare offers expert resources to assist you in navigating the selection process for the right plan.
Whether you need help understanding the benefits of different plans or have specific questions about coverage, these experts are available to guide you.
While conversing with experts, it’s necessary to ask about the following when considering Simply Healthcare plans:
- Coverage options
- Integration of the plan with Medicare
- Specifics about the provider network
- Any extra services or programs
- Quality measures implemented
This ensures you have all the information you need to make an informed decision.
Maximizing Your Benefits with Simply Healthcare
Getting the most out of your Simply Healthcare plan involves more than just choosing the right plan. You can maximize your benefits by taking advantage of wellness and preventive services, managing chronic conditions, and utilizing member resources and support.
Wellness and Preventive Services
Wellness and preventive services are key aspects of Simply Healthcare’s Medicare Advantage plans.
These services include dental and vision coverage, membership to SilverSneakers® fitness program, a no-cost fitness benefit, and access to telehealth visits. This means you have a range of options to maintain your health and prevent potential health issues.
Besides these services, Simply Healthcare also offers a variety of preventive care services, such as:
- regular well visits
- immunizations
- an array of health services tailored for various ages via the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program
And the best part? Members are not required to pay extra for these wellness and preventive services as they are fully covered at 100%.
Managing Chronic Conditions
Managing chronic conditions is a key aspect of healthcare, and Simply Healthcare offers comprehensive support in this area. They offer a system of coordinated care management interventions and communications to assist in managing chronic conditions.
They have developed 13 disease management programs that emphasize member self-care, care coordination across providers, and education and support. This provides a comprehensive approach to managing chronic conditions.
Simply Healthcare focuses on managing a variety of chronic conditions, including:
- Alzheimer’s disease/dementia
- Asthma
- Bipolar disorder
- Chronic obstructive pulmonary disease (COPD)
- Diabetes mellitus
- Chronic heart failure
- Cardiovascular disorder
So, regardless of your condition, you can rest assured that Simply Healthcare has the resources and expertise to help you manage it effectively.
Member Resources and Support
When you join Simply Healthcare, you gain access to a range of resources and support services designed to help you get the most out of your plan.
These include a community resource link for assistance with various needs, member handbooks, and a nurse helpline for health-related inquiries. This ensures you have the support you need when you need it.
Along with these resources, Simply Healthcare also offers online resources including commonly used forms, provider manuals, details about prior authorization, and practice policies.
Moreover, Health A to Z provides an online health resource with tools for locating doctors or hospitals, changing primary care physicians, and secure messaging. This means you have a wealth of resources at your fingertips, ensuring you can make the most of your Simply Healthcare plan.
Eligibility and Requirements for Simply Healthcare Plans
Before you can enroll in a Simply Healthcare plan, you need to meet certain eligibility and requirements.
These include:
- Being entitled to Medicare Part A
- Enrolled in Medicare Part B
- Providing essential documents including proof of identity, residency, income, and citizenship or immigration status.
Who Can Enroll?
Individuals must be entitled to Medicare Part A and enrolled in Medicare Part B to enroll in Simply Healthcare Medicare Advantage plans.
This guarantees that those who enroll in Simply Healthcare plans can access the extensive coverage they offer.
However, enrollment in Simply Healthcare Medicare Advantage plans is contingent upon contract renewal and meeting the eligibility requirements. This means that even if you meet the initial eligibility criteria, you must continue to meet these criteria to maintain your enrollment.
Even non-US citizens can enroll in Simply Healthcare Medicare Advantage plans if they meet the requirements for Medicare eligibility.
Geographic Availability
A significant factor to consider when selecting a healthcare plan is its geographic availability. Simply Healthcare offers Medicare Advantage Plans exclusively in the state of Florida. This means that you must be a resident of Florida to enroll in a Simply Healthcare plan.
More specifically, Simply Healthcare offers Medicare Advantage Plans in the following counties within Florida:
- Broward County
- Hernando County
- Hillsborough County
- Miami-Dade County
- Orange County
Therefore, if you live in these counties, you have access to the comprehensive healthcare coverage offered by Simply Healthcare.
Special Needs Plan Eligibility
SNPs are a distinct category of Medicare Advantage plans designed to support individuals with specific healthcare needs. They are particularly designed to provide specialized care for those diagnosed with certain conditions or diseases, as well as individuals with low incomes.
Florida residents with diabetes, a cardiovascular disorder, or chronic heart failure can access Simply Healthcare’s SNPs. These special needs plans cater to those specific health conditions. This ensures that individuals with these conditions have access to the specialized care they need.
Moreover, a Dual-Eligible SNP is a particular category of Medicare Special Needs Plan designed for individuals who qualify for both Medicare Part A and Part B, along with Florida Medicaid.
This ensures that individuals who meet these criteria have access to comprehensive coverage that meets their healthcare needs.
Summary
Simply Healthcare offers a range of Medicare Advantage plans designed to meet a variety of healthcare needs. Whether you are looking for basic coverage, need assistance managing a chronic condition, or are seeking a plan with additional benefits like dental and vision coverage, Simply Healthcare has a plan for you.
By understanding the benefits, comparing the options, and utilizing the resources available, you can find the Simply Healthcare plan that best fits your needs.
Frequently Asked Questions
→ What is the best Medicare Advantage plan for seniors?
The best Medicare Advantage plan for seniors is AARP’s UHC plan, which offers high star ratings, a large provider network, and a wide range of options.
UnitedHealthcare (UHC) is the largest provider of Medicare Advantage plans.
→ What are the key features of Simply Healthcare Medicare Advantage Plans?
Simply Healthcare Medicare Advantage Plans offer Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) coverage for Medicare beneficiaries in Florida, including coordinated care plans and a Medicaid contract with the State of Florida Agency for Health Care.
→ What are the additional benefits provided by Simply Healthcare beyond Original Medicare?
Simply Healthcare offers additional benefits beyond Original Medicare, such as vision and dental coverage, fitness benefits, and telehealth visits, among others. These extra benefits can provide comprehensive healthcare coverage.
→ What are the steps to compare the features of different Simply Healthcare plans?
When comparing Simply Healthcare plans, you should assess the plan structure, benefits, Medicare Star Ratings, and the comprehensiveness of coverage.
By evaluating these factors, you can make an informed decision about which plan best suits your needs.
→ What are the support services offered by Simply Healthcare for managing chronic conditions?
Simply Healthcare offers a comprehensive system of coordinated care management interventions and communications, including 13 disease management programs focused on member self-care, care coordination, and education and support to assist in managing chronic conditions.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.