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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 2025, 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 2025.
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 $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 $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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, standard generic drugs have a $20 copay, preferred brand drugs have a $60 copay, and specialty tier drugs have a $10 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Advantage Care COPD by Ultimate (HMO C-SNP) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. This plan also covers primary care, preventive services, hearing, vision, dental, and home health services. Emergency, ambulance, and transportation services are covered, with copays and coinsurance depending on the specific service. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services. The plan also covers skilled nursing facility services, and offers a meal benefit for chronic illnesses. However, some services are not covered, such as cardiac rehabilitation, and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For days 1-5, there is a $115 copay, and for days 6-90, there is no copay. Additional days are covered for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with 1 additional day per benefit period, but Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $75 and $150, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $20 copay for individual sessions and a $10 copay for group sessions, and Outpatient Blood Services. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan, but requires prior authorization and a doctor's referral. The plan does not specify cost information for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. 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, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan. Emergency Services has a $50 copay, Urgently Needed Services has a $10 copay, and Worldwide Emergency Coverage has a $100 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Under the Advantage Care COPD by Ultimate (HMO C-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Chiropractic services have a $20 copay, physician specialist services have a $20 copay, individual and group sessions for mental health specialty services have a $20 copay, other health care professional services have a minimum $20 copay, individual and group sessions for psychiatric services have a minimum $20 copay, physical therapy and speech-language pathology services have a $30 copay, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional preventive services like Health Education, Medical Nutrition Therapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
The Advantage Care COPD by Ultimate (HMO C-SNP) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). This plan also covers prescription hearing aids up to $1,000 per ear per year, but does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, and does not cover OTC hearing aids.
Vision Services See details
Vision Services include routine eye exams once per year, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum of $200.00 per year. Upgrades have a copay of $30.00 - $50.00.
Dental Services See details
Dental services are covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, prosthodontics, fixed and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and other Medicare Part B drugs. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay of up to $150, and Lab Services have no copay and a coinsurance of up to 20%. Diagnostic Radiological Services have a copay of up to $150, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan with no copay and no coinsurance, but requires authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 39-100, while there is a $150 copay for days 21-38.
Other Services See details
Other Services for Advantage Care COPD by Ultimate (HMO C-SNP) includes a meal benefit for chronic illnesses, but 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.
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