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Advantage Care by Ultimate (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Care by Ultimate (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Advantage Care by Ultimate (HMO C-SNP) in 2026, please refer to our full plan details page.
Advantage Care by Ultimate (HMO C-SNP) is a HMO C-SNP plan offered by Ultimate Healthcare Holdings, LLC available for enrollment in 2025 to people living in Citrus, Hernando, and Pasco counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Advantage Care by Ultimate (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Advantage Care by Ultimate (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Advantage Care by Ultimate (HMO C-SNP).
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 Advantage Care by Ultimate (HMO C-SNP), 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 $1750.00 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 Advantage Care by Ultimate (HMO C-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for 1-month or 3-month supplies at standard pharmacies, nor is there a copay for a 3-month standard mail order. Select Care Drugs in Tier 6 are also highly affordable, requiring a $10 copay for a 1-month supply at a standard pharmacy or a $20 copay for a 3-month standard mail order. For higher-tier medications, Tier 3 preferred brands require a $20 copay for a 1-month supply at standard pharmacies or a $40 copay for a 3-month standard mail order. Tier 4 non-preferred drugs require a 35% coinsurance for both 1-month and 3-month supplies. Specialty drugs in Tier 5 carry a 33% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
Advantage Care by Ultimate (HMO C-SNP) offers comprehensive medical coverage with affordable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and a low $3 copay for specialist visits and therapy sessions. Inpatient hospital stays require a $65 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $50 copay. Emergency care is available with a $120 copay, which is waived if you are admitted, and urgent care requires a $10 copay. The plan also includes valuable supplemental benefits such as routine dental, vision, and hearing services with no copay or coinsurance, including a $400 annual eyewear allowance and up to $1,000 per ear for prescription hearing aids. Additionally, members benefit from unlimited one-way transportation to plan-approved locations, a $100 monthly allowance for over-the-counter items, and home health services with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $65 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Advantage Care by Ultimate (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $50 copay for outpatient hospital services, a $60 copay per stay for observation services, and a $25 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $10 to $20 copay, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Advantage Care by Ultimate (HMO C-SNP), with ground ambulance services requiring a $200 copay (no coinsurance) and air ambulance services requiring a 20% coinsurance (no copay), both subject to prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related locations is not covered.
Emergency Services See details
Advantage Care by Ultimate (HMO C-SNP) 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 you are admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 lifetime maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care by Ultimate (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while opioid treatment services require a 20% coinsurance and no copay. Specialist visits, mental health sessions, and physical, occupational, and speech therapies are covered with a $3 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered benefits, although some services require referrals or prior authorization. While benefits like health education, glaucoma screenings, and diabetes self-management training are covered, annual physical exams, in-home safety assessments, personal emergency response systems (PERS), and weight management programs are not covered.
Hearing Services See details
Hearing services under Advantage Care by Ultimate (HMO C-SNP) are partially covered with no copay and no coinsurance, offering one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are covered up to $1,000 per ear yearly with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers vision services, offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no coinsurance and no deductible up to a $400 annual limit for contact lenses or one pair of eyeglasses, with upgrades available for a $30 to $50 copay.
Dental Services See details
Dental services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered preventive and comprehensive benefits. Services not covered under this plan include other diagnostic, other preventive, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Advantage Care by Ultimate (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Advantage Care by Ultimate (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, both requiring prior authorization. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Advantage Care by Ultimate (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all services. Lab and diagnostic radiological services feature no copays or coinsurance, while diagnostic tests range from a $0 to $50 copay with coinsurance, outpatient X-rays have no copay with coinsurance, and therapeutic radiology requires a copay and 20% coinsurance.
Home Health Services See details
Home health services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Advantage Care by Ultimate (HMO C-SNP) offers cardiac rehabilitation services with no coinsurance and prior authorization required, though only some services are covered. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Peripheral Artery Disease (PAD) services are not covered and require a $5.00 copayment.
Skilled Nursing Facility (SNF) See details
Advantage Care by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 39 to 100, and a $120 copay for days 21 to 38. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers other services, providing a chronic illness meal benefit and a $100 monthly over-the-counter item allowance with no copay and no coinsurance. Acupuncture is not covered under this plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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