Simply Extra Platinum (HMO) Medicare Advantage Plan H5471-117 • 2026 • Hernando County, FL

Simply Extra Platinum Overview

Plan Details for Simply Extra Platinum

With a monthly premium of $0.00, Simply Extra Platinum is a Medicare Advantage HMO plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. Services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $0.00.

Primary care visits have a $0 copay, specialist visits come with a $30 copay, urgent care services carry a $30 copay, and ambulance transportation is $250 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3200.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H5471-117. Cost-sharing details are provided below.

Cost-Sharing Overview

Simply Extra Platinum has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5471-117.

Certain preventive services are covered 100% by Simply Extra Platinum as a Part B benefit.

Prescription Drug Coverage

Simply Extra Platinum includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Simply Healthcare Plans, Inc. starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Simply Extra Platinum may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS Star Ratings

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.