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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 Counties: HER, HIL, PAS, PIN. 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 $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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, members pay no copay for 1-month and 3-month supplies at a standard pharmacy, and no copay for a 3-month supply through standard mail order. These cost-saving benefits help keep everyday maintenance medications highly affordable. Higher-tier medications require copays or coinsurance, such as a $20 copay for Tier 3 preferred brands and a $10 copay for Tier 6 select care drugs for a 1-month supply at a standard pharmacy. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty drugs have a 33% coinsurance for a 1-month supply at a standard pharmacy. Standard mail order provides additional savings on 3-month supplies, reducing Tier 3 drug copays to $40 and Tier 6 drug copays to $20.
Additional Benefits
The Advantage Care COPD by Ultimate (HMO C-SNP) offers robust coverage with highly affordable cost-sharing for your essential medical needs. Members enjoy no copay for primary care physician visits and a low $3 copay for specialist, mental health, and therapy appointments. Inpatient hospital stays require a $75 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $70 copay. In addition to medical care, this plan provides excellent supplemental benefits to support your daily health and wellness. You will pay no copay for routine dental care, annual hearing exams, a yearly eye exam, and home health services. The plan also includes valuable extras with no copay, such as unlimited transportation to plan-approved health locations and a $110 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Advantage Care COPD by Ultimate (HMO C-SNP), featuring no coinsurance for acute and psychiatric stays with a $75 daily copay for days 1 to 5 and no copay for days 6 to 90. Prior authorization and referrals are required for these stays, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers outpatient services with no coinsurance, requiring a $70 copay for outpatient hospital and observation services and a $25 copay for ambulatory surgical center services. Outpatient substance abuse services have a $10 copay for group sessions and a $20 copay for individual sessions, 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 access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Advantage Care COPD by Ultimate (HMO C-SNP), with ground ambulance services requiring a $200 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no 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 other 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 benefit and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum limit with a $100 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialists, mental health, and therapy services require a $3 copay and no coinsurance. Opioid treatment services are covered with no copay and a 20% coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and no coinsurance for all covered care. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Hearing services are partially covered by Advantage Care COPD by Ultimate (HMO C-SNP), featuring no copay and no coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to $1,000 per ear. However, OTC hearing aids and specific prescription types—including inner ear, outer ear, and over-the-ear models—are not covered.
Vision Services See details
Vision services are partially covered by Advantage Care COPD by Ultimate (HMO C-SNP), which excludes other eye exam services but covers one routine eye exam annually with no copay and no coinsurance. Eyewear is covered with no coinsurance, a $30 to $50 copay for upgrades, and a $400 annual limit.
Dental Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) partially covers dental services with no copay and no coinsurance for covered benefits. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers Home Infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs require no copay and 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 access these benefits.
Medical Equipment See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers durable medical equipment with no copay and ranging from no coinsurance to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, including diabetic supplies and therapeutic shoes or inserts, is 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. Lab services and outpatient X-rays feature no copay, diagnostic procedures range from a $0 to $70 copay, and diagnostic radiological services have no copay, while coinsurance and copays apply to therapeutic and other diagnostic tests.
Home Health Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Advantage Care COPD by Ultimate (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Advantage Care COPD by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 to 20 and days 39 to 100, a $150 copay for days 21 to 38, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Advantage Care COPD by Ultimate (HMO C-SNP) offers partial coverage for other services, including a meal benefit for chronic illness and a $110 monthly allowance for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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