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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 Hillsborough and Pinellas 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 $170.00. 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 $1600.00 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 varying copays for your prescriptions depending on the drug tier. For example, you will pay no copay for preferred generic drugs and $20 for standard generic drugs. For non-preferred drugs, you will pay 33% coinsurance, and $10 for specialty tier drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, including surgery, have copays ranging from $25 to $150. The plan covers ambulance services with a copay or coinsurance, and emergency services have a copay. This plan provides coverage for primary care, hearing, vision, and dental services with some cost-sharing. Hearing services include exams and hearing aids with a maximum benefit, while vision includes exams and eyewear. Dental covers exams, x-rays, and cleanings. Additionally, the plan covers home infusion, dialysis, medical equipment, and home health services with copays or coinsurance, while offering no copay for home health services.
Inpatient Hospital See details
Inpatient hospital benefits are covered, but require prior authorization and a doctor referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $60 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $75-$150, observation services with a copay of $150, Ambulatory Surgical Center (ASC) services with a copay of $25, and outpatient substance abuse services with a copay of $10-$20 for individual and group sessions. Outpatient blood services are also covered.
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), including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance.
Emergency Services See details
Emergency Services include a $75 copay for emergency services and no coinsurance, while Urgently Needed Services have a $10 copay and no coinsurance. Worldwide Emergency Coverage has a $100 copay, and no coinsurance, but 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, chiropractic, occupational therapy, physician specialist, mental health specialty, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Chiropractic services have a $10 copay, and occupational therapy services have a $10 copay, while the plan does not cover routine chiropractic care. Specialist and mental health services have a $10 copay, and physical therapy and speech-language pathology services have a $10 copay, while opioid treatment program services have 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, health education, medical nutrition therapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, 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 EKGs following a welcome visit. 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 are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams and fitting/evaluation for hearing aids, with one visit per year, and prescription hearing aids with a maximum benefit of $1,000 per year; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $300 per year. The plan also covers contact lenses, eyeglasses (lenses and frames) with one pair per year, and upgrades with a copay of $30-$50.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are also covered, but require prior authorization. Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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) and 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 by Advantage Care by Ultimate (HMO C-SNP), with Durable Medical Equipment (DME) requiring prior authorization and 20% coinsurance, and Prosthetic Devices and Medical Supplies also requiring prior authorization and 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $150, Lab Services with no copay and up to 20% coinsurance, Diagnostic Radiological Services with a copay up to $150, Therapeutic Radiological Services with up to 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan with no copay and no coinsurance, but require 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 by Ultimate (HMO C-SNP) plan. While Cardiac Rehabilitation Services are generally covered, this plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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. 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 for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan's "Other Services" benefit does not cover 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. The plan offers a meal benefit for a chronic illness, with no maximum coverage amount.
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