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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 Counties: HER, HIL, PAS, PIN. 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 $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 COPD by Ultimate (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, $15 for standard generic drugs, and $55 for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you may have reduced premiums.
Additional Benefits
The Advantage Care COPD by Ultimate (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $60 copay for days 1-5 and no copay for days 6-90, while outpatient services have copays ranging from $10 to $70. The plan also covers ambulance services, with a $150 copay for ground and 20% coinsurance for air, as well as emergency services with copays between $10 and $75. This plan includes coverage for primary care, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services. Primary care and specialist visits have a $7 copay, and the plan provides hearing aids with a $1,000 annual maximum. Dental services include exams, x-rays, and cleanings, and skilled nursing facilities have no copay for certain days.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For inpatient hospital stays, you will pay a $60 copay for days 1-5 and no copay for days 6-90, and additional days are covered for both acute and psychiatric care.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $70 copay, observation services with a $70 copay, ambulatory surgical center (ASC) services with a $25 copay, outpatient substance abuse services, and outpatient blood services. Outpatient substance abuse services include individual sessions with a $20 copay and group sessions with a $10 copay.
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 referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $150 copay, and air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are also 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 have a $75 copay, Urgently Needed Services have 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
The Advantage Care COPD by Ultimate (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic, occupational therapy, specialist, mental health, and other healthcare professional services have a $7 copay, and opioid treatment program services have 20% coinsurance.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered preventive services with a doctor referral, and additional preventive services. This 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, or counseling services.
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). The plan also covers prescription hearing aids (all types) with a maximum benefit of $1,000 per year, but does not cover prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids are also not covered.
Vision Services See details
The Advantage Care COPD by Ultimate (HMO C-SNP) plan covers vision services including routine eye exams once per year, and eyewear with a combined maximum benefit of $300 per year. Eyewear upgrades have a copay of $30-$50.
Dental Services See details
Dental services are covered, including oral exams (2 visits), dental x-rays (2 per year), prophylaxis (cleaning) (1 visit every six months), fluoride treatment (1 visit every six months), restorative services (4 visits per year) and oral and maxillofacial surgery (2 visits per year), with some services requiring 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 COPD by Ultimate (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, and there is a coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs that ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by the Advantage Care COPD by Ultimate (HMO C-SNP) plan, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, 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 include coverage for all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic procedures/tests have a copay of up to $70, while lab services have no copay and a coinsurance of at most 20%. Diagnostic and therapeutic radiological services have a coinsurance, while diagnostic radiological services have a copay of up to $75. 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 require prior 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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also 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. For days 1-20, there is no copay, for days 21-38, the copay is $150, and for days 39-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Advantage Care COPD by Ultimate (HMO C-SNP) plan's Other Services benefit covers a meal benefit for chronic illness, 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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