Simply Healthcare Plans Guide

Simply Healthcare Plans, part of the WellCare/Elevance family, offers Medicaid and Medicare coverage in Florida with a focus on coordinated care for families, children, and seniors. In Miami, Simply connects members to primary care providers, specialists, and hospitals.

Because Simply concentrates on Medicaid and Medicare populations, eligibility depends on program-specific criteria such as income for Medicaid or age and disability for Medicare. Confirm which Simply product you have, since networks and benefits differ across programs.

Simply offers Medicaid managed care plans for eligible Floridians and Medicare Advantage plans for members 65 and older or who qualify due to disability. Some members qualify for dual-eligible special needs plans that combine Medicaid and Medicare.

Medicaid members generally pay little or nothing for covered services, while Medicare Advantage members may have plan premiums, copays, and extra benefits. Matching the plan to your eligibility is the first step to using Simply effectively.

Simply plans cover the essential health benefits, including preventive care, primary and specialist visits, emergency services, hospitalization, maternity, mental health services, and prescription drugs. Medicare Advantage products often add dental, vision, and wellness benefits.

Simply emphasizes care coordination and support for members with chronic or complex needs. As with any plan, confirm prior-authorization requirements and formulary tiers before scheduling non-emergency procedures or filling new prescriptions.

Medicaid members typically face minimal out-of-pocket costs, while Medicare Advantage members have copays, coinsurance, and an annual out-of-pocket maximum. Some Simply Medicare plans offer $0 premiums but may have copays for certain services.

Because Simply uses managed-care networks, staying in network is essential. Medicaid and Medicare eligibility are determined by program rules, so members should keep their information current to avoid coverage gaps.

Confirm a clinic is in-network for your exact Simply plan before visiting by using the online provider directory, calling member services on your card, or asking the front desk to verify your specific Simply product.

Miami-Dade County has many Simply-participating providers, especially for Medicaid and Medicare members, but networks change over time. When searching for care here, filter by your insurance and call ahead to reconfirm before specialist visits or procedures.