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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 2025, 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 2025.
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 $174.70. 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and the pharmacy you use. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, and a $15 copay for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), the plan's premium may be reduced.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency services have a $60 copay, while primary care visits have no copay. Other services such as vision, dental, hearing, and home health services are also covered. This plan provides additional coverage for services like ambulance, home infusion, and dialysis, with specific cost-sharing arrangements. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays, but some services require prior authorization. However, it is important to note that some services, such as certain dental and vision procedures, have limitations on coverage.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $50 copay for days 1-5, and no copay for days 6-90. Additional days are covered with 1 additional day per benefit period, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a $50 copay, Observation Services have a $60 copay, Ambulatory Surgical Center Services have a $25 copay, and Individual Sessions for Outpatient Substance Abuse have a $20 copay, while Group Sessions for Outpatient Substance Abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Advantage Care by Ultimate (HMO C-SNP), but requires prior authorization and a doctor referral. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Advantage Care by Ultimate (HMO C-SNP). Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services are covered by Advantage Care by Ultimate (HMO C-SNP), with a $60 copay and no coinsurance. Urgently Needed Services have a $10 copay and no coinsurance. Worldwide Emergency Coverage has a $100 copay and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $10 copay, physician specialist services with a $5 copay, and mental health specialty services with a $5 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $10 copay, and opioid treatment program services have 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, additional preventive services, kidney disease education services, and other preventive services. The plan does not cover annual physical exams, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for 1 visit per year. Prescription hearing aids are covered up to $1,000 per year, and the plan covers prescription hearing aids (all types) for 2 visits per year, but does not cover prescription hearing aids for inner ear, outer ear, or over the ear.
Vision Services See details
Advantage Care by Ultimate (HMO C-SNP) covers vision services, including routine eye exams with no copay and eyewear with a combined maximum of $300.00 per year, and upgrades with a copay between $30.00 and $50.00. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered.
Dental Services See details
Dental services are covered, including oral exams with 2 visits, dental x-rays with 2 visits, prophylaxis (cleaning) with 1 visit every six months, and fluoride treatment with 1 visit every six months. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are also covered, but require prior authorization. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan, with a $35 copay for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Advantage Care by Ultimate (HMO C-SNP), but require prior authorization and a doctor's referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies also have a 20% coinsurance, while there is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with coinsurance, diagnostic procedures/tests with a copay between $0 and $50, and lab services with no copay and a coinsurance of up to 20%. Radiological services include coverage for diagnostic radiological services with a copay of up to $75, therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan, with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Advantage Care by Ultimate (HMO C-SNP), but the plan does not cover any of the specific services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Advantage Care by Ultimate (HMO C-SNP), but require prior authorization and a doctor's referral. There is no copay for days 1-20, a $120 copay for days 21-38, and no copay for days 39-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Advantage Care by Ultimate (HMO C-SNP) plan, acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan does offer a Meal Benefit for chronic illness, but does not specify any cost information.
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