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Welcome to Simple – your easy-to-read benefits summary.
Medicare Advantage Only
Medicare Advantage & Medicaid
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Simple Sample Plan GiveBack TX-P007 (PPO)
Monthly premium
$000
Medical Deductiable
$000
MOOP In Network
$000
Discover the Benefits
Dental Benefit
You get up to $500 every year to use for preventive and comprehensive dental care with any licensed dentist. This allowance does not cover cosmetic procedures and may require you to pay upfront if the provider is out-of-network.
Includes one routine eye exam per year at no cost and up to $100 annually toward eyewear like glasses or contacts from network providers. Medicare-covered vision services like diabetic eye exams and glaucoma screenings are also included.
Vision Benefits
Hearing Benefits
Covers one routine hearing exam and one fitting/evaluation per year at no cost. You can get hearing aids for $399–$1,800 per device, limited to two per year, through ______ approved hearing vendor.
Monthly Premuim, Deductible and MOOPs
See how much you'll pay for this plan including your premiums, deductible and maximum out-of-pocket cost
Benefits Name
Cost
Info
Detail
Monthly Premium
$0
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Medical Deductible
$0
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Drug Deductible
$0
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MOOP In-Network
$6,500
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MOOP out-of-Network
$9,700
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MOOP Total
$14,500
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Part B Premium
$185
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Part B Giveback
$137.50
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This information was generated using your Evidence of Coverage (EOC) document, with the help of advanced AI technology to summarize and organize the details for you. While we do our best to make sure everything is accurate, mistakes can happen. If you notice anything missing or incorrect, please give me a call — I’m happy to help clarify or update it for you!
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