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Premier by Ultimate (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Premier by Ultimate (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Premier by Ultimate (HMO) in 2026, please refer to our full plan details page.
Premier by Ultimate (HMO) is a HMO plan offered by Ultimate Healthcare Holdings, LLC available for enrollment in 2025 to people living in Counties: CIT, HER, IDR, PAS, STL. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Premier by Ultimate (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Premier by Ultimate (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Premier by Ultimate (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $185.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Premier by Ultimate (HMO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for a 1-month or 3-month supply at standard pharmacies, as well as no copay for a 3-month supply through standard mail order. This makes managing everyday essential prescriptions highly affordable. For Tier 3 preferred brand drugs, standard pharmacy copays are $30 for a 1-month supply and $90 for a 3-month supply, while standard mail order offers a 3-month supply for a $60 copay. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The Premier by Ultimate (HMO) plan delivers comprehensive healthcare coverage with low out-of-pocket costs, including no copay for primary care visits and a budget-friendly $10 copay for specialist consultations. Inpatient hospital stays require an $80 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $75 copay. Emergency room visits have a $120 copay and urgently needed care has a $10 copay, with both fees waived if you are admitted. Beyond standard medical care, this plan offers valuable everyday wellness benefits with no copay and no coinsurance, such as routine dental cleanings, annual eye exams with a $400 eyewear allowance, and yearly hearing exams with a $1,000 hearing aid allowance per ear. Members also receive up to $90 per month for over-the-counter items and 20 one-way trips to plan-approved locations at no cost. Essential services like preventive care, home health visits, and cardiac rehabilitation are also covered with no copay and no coinsurance.
Inpatient Hospital See details
Premier by Ultimate (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring an $80 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades and non-Medicare-covered stays are not covered under this benefit, and prior authorization and referrals are required.
Outpatient Services See details
Premier by Ultimate (HMO) covers outpatient services with no coinsurance, featuring a $75 copay for outpatient hospital and observation services and a $25 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $15 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Premier by Ultimate (HMO) with a $55.00 copay and no coinsurance. This benefit requires prior authorization and a referral before services can be received.
Ambulance and Transportation Services See details
Premier by Ultimate (HMO) offers ambulance and transportation services, with transportation being partially covered as trips to any health-related location are not covered. Ground ambulance services require a $200 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Covered transportation to plan-approved locations is limited to 20 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Premier by Ultimate (HMO) covers emergency services with a $120 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Premier by Ultimate (HMO) offers primary care, physical therapy, and speech-language services with no copay and no coinsurance, while specialist, occupational therapy, mental health, and psychiatric services require a $10 copay and no coinsurance. Opioid treatment is covered with no copay and 20% coinsurance, but podiatry is not covered and chiropractic care is only partially covered.
Preventive Services See details
Preventive services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance, though some services like annual physical exams, in-home safety assessments, and personal emergency response systems are not covered. Covered benefits include kidney disease education, glaucoma screenings, diabetes self-management training, and select fitness services, with some requiring prior authorization or a referral.
Hearing Services See details
Hearing services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance for annual routine hearing exams, fitting evaluations, and prescription hearing aids, which include a maximum coverage limit of $1,000 per ear every year. This benefit is partially covered, as OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Premier by Ultimate (HMO) covers vision services, offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no coinsurance and up to a $400 annual maximum for contacts or one pair of eyeglasses, with a $30 to $50 copay for upgrades.
Dental Services See details
Dental services are partially covered by Premier by Ultimate (HMO) with no copay and no coinsurance for covered care such as exams, cleanings, x-rays, fluoride, restorative services, periodontics, and oral surgery. Some services are not covered, including other diagnostic, other preventive, endodontics, implants, fixed or removable prosthodontics, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Premier by Ultimate (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Premier by Ultimate (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Premier by Ultimate (HMO) covers medical equipment with no copay, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Premier by Ultimate (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Lab services have no copay and no coinsurance, diagnostic radiological services require a minimum $25 copay with no coinsurance, and therapeutic radiological services require a copay and minimum 20% coinsurance. Diagnostic procedures require a $25 to $75 copay plus coinsurance, while outpatient X-rays have no copay but require coinsurance.
Home Health Services See details
Premier by Ultimate (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required for care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Premier by Ultimate (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy rehabilitation services are not covered in practice and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Premier by Ultimate (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 41 through 100, and a $150 daily copay for days 21 through 40. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Premier by Ultimate (HMO) partially covers other services, offering a meal benefit for chronic illness and up to $90 per month in over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, naloxone, and other additional services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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