Simply Extra Platinum (HMO) 2026 Plan Details for Miami-Dade County, Florida Residents
Simply Extra Platinum (HMO) 2026 Plan Details for Miami-Dade County, Florida Residents
Navigating your Medicare Advantage options in Miami-Dade County for 2026 can be overwhelming, but we're here to help. With Simply Extra Platinum (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 4,020 Medicare beneficiaries are enrolled in this plan, with 4,020 members in Miami-Dade County, FL.
Simply Extra Platinum Overview
| Plan ID H5471-113-0 Overview | |
|---|---|
| Health Plan ID: | H5471-113-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $2450.00 (In-Network) |
| Part B Give Back: | −$164.90 reduction |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Miami-Dade County, FL |
| Insured By: | Simply Healthcare Plans, Inc. |
Why Consider Simply Extra Platinum?
With a monthly premium of $0.00, Simply Extra Platinum brings together hospital, medical, and prescription drug coverage in one coordinated Medicare Advantage HMO plan. It includes the core benefits of Medicare Part A and Part B, plus drug coverage to help manage your ongoing prescriptions. The annual Part D deductible is $0.00. As with most HMO plans, you’ll typically need to use in-network providers to keep costs predictable.
Primary care visits have a $0 copay, specialist visits come with a $0 copay, urgent care services carry a $0 copay, and ambulance transportation is $150 copay. These expenses count toward the plan’s maximum out-of-pocket (MOOP) limit of $2450.00. Once you reach that limit, your in-network care is covered at 100% for the rest of the year — a strong choice for anyone who wants bundled coverage and financial protection they can count on.
You’ll find this plan listed by CMS as H5471-113-0. You'll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
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Cost-Sharing Overview
Simply Extra Platinum has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5471-113-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $0 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | Not covered |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $150 copay |
| Wordwide emergency care: | $150 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $75 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $60 per day for days 21-100 |
| Ground ambulance: | In-network: $150 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $75 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $15 copay |
| Occupational therapy: | In-network: $15 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$75 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0-$75 copay |
| Diagnostic tests and procedures: | In-network: $0-$75 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Simply Extra Platinum as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Simply Extra Platinum includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $-42.30 |
|---|---|
| Supplemental Part D Premium: | $42.30 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $4.82 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
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.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $10.00 copay | Coming soon |
| Non-Preferred Drug | $50.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Supplemental Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Simply Extra Platinum
You are eligible to enroll in Simply Extra Platinum if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Simply Extra Platinum and take advantage of its full range of benefits.
When Can I Enroll in Simply Extra Platinum?
To ensure you don’t miss your chance to enroll in Simply Extra Platinum, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for Simply Extra Platinum
Enrolling in Simply Extra Platinum is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Simply Extra Platinum through the official Medicare website.
- Directly with Simply Extra Platinum: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H5471-113-0:
Is there a premium for this plan in 2026?
The 2026 premium is $0.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
For 2026, the maximum you’d spend out-of-pocket in-network is $2450.00.
Is there a Part D deductible with this plan?
You’ll pay the first $0.00 in drug costs before coinsurance kicks in.
Is this a 4-star or 5-star plan?
For 2026, plan H5471-113-0 has a ★4.5 rating. The best rating is 5 stars.
Is Simply Extra Platinum popular?
CMS reports 4,020 members in the latest file.
Contact Simply Healthcare Plans, Inc.
| Contact Type | Details |
|---|---|
| Website: | Simply Healthcare Plans, Inc. Plan Page |
| New Members: | 1-833-668-2296 |
| Existing Members: | 1-877-577-0115 |
| Plan Address: | 11430 NW 20th Street | Suite 300 | Miami, FL 33172 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Simply Healthcare Plans, Inc., http://shop.simplyhealthcareplans.com/medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
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