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Advantage Care COPD by Ultimate (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Care COPD 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 COPD by Ultimate (HMO C-SNP) in 2026, please refer to our full plan details page.
Advantage Care COPD 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 Central Florida. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Advantage Care COPD 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 COPD 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 COPD 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 COPD 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 $2600.00 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 COPD by Ultimate (HMO C-SNP) prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately with no upfront costs. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for both 1-month and 3-month supplies at standard pharmacies, as well as for 3-month mail-order fills. This plan offers a highly cost-effective option for individuals looking to minimize their routine medication expenses. For brand-name and specialized medications, Tier 3 preferred brand drugs carry a $20 copay for a 1-month standard pharmacy supply and a $40 copay for a 3-month mail order. Tier 6 select care drugs require a $10 copay for a 1-month supply or a $20 copay for a 3-month mail order. Higher-tier prescriptions involve coinsurance, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance for a 1-month supply.
Additional Benefits
The Advantage Care COPD by Ultimate (HMO C-SNP) plan offers affordable healthcare coverage with no copay for primary care physician visits and a low $3 copay for specialist appointments. Inpatient hospital stays require a $115 daily copay for the first five days, followed by no copay for days six through 90, with no coinsurance. Emergency room visits carry a $120 copay, while urgently needed services cost just $10. Additional benefits include preventive and comprehensive dental care, routine hearing exams, and annual eye exams with no copay or coinsurance. Members also receive a $400 annual allowance for eyewear, unlimited rides to plan-approved health locations at no cost, and a $110 monthly allowance for over-the-counter products. Home health care and skilled nursing facility stays for up to 20 days are also fully covered with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Advantage Care COPD by Ultimate (HMO C-SNP) with no coinsurance, requiring a $115 copay per day for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Prior authorization and referrals are required, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Advantage Care COPD by Ultimate (HMO C-SNP) feature no coinsurance, with copays ranging from $75 to $150 for hospital services, $150 per stay for observation services, and $25 for ambulatory surgical center services. Outpatient substance abuse services require a $10 to $20 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers ground ambulance services with a $200 copay and a coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers emergency services with a $120 copay and urgently needed services with a $10 copay, with no coinsurance for either service and 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, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care COPD by Ultimate (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and mental health services feature a $3 copay and no coinsurance. Opioid treatment programs are covered with no copay and 20% coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and no coinsurance, though some services require referrals or prior authorization. Sub-services that are not covered include annual physical exams, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered under Advantage Care COPD by Ultimate (HMO C-SNP) with no deductible, no copay, and no coinsurance for annual routine exams and fitting evaluations. For prescription hearing aids, some services are covered but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are covered by Advantage Care COPD by Ultimate (HMO C-SNP), offering one routine eye exam per year with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no coinsurance, no deductible, and a $400 annual maximum for contacts or glasses, with copays ranging from $30 to $50 for upgrades.
Dental Services See details
Dental services are partially covered under Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and no coinsurance for all covered preventive and comprehensive care. Covered benefits include oral exams, cleanings, x-rays, restorative services, endodontics, periodontics, and oral surgery, while implants, orthodontics, fixed prosthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs feature no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all services. Lab services are offered with no copay and no coinsurance, outpatient X-rays have no copay (coinsurance applies), and other diagnostic and therapeutic services carry copays ranging from $0 to $150 and coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered under Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and no coinsurance, though both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) offers coverage for some Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, specific programs such as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD are not covered in practice, carrying a $5 copay.
Skilled Nursing Facility (SNF) See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services for up to 100 days with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 to 20 and days 39 to 100, but a $150 daily copay applies for days 21 to 38, with prior authorization and referrals required.
Other Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) partially covers other services, offering a chronic illness meal benefit and a monthly over-the-counter item allowance of up to $110 with no copay and no coinsurance. Acupuncture is not covered under this plan.
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