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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 2026, 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 2026.
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 $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 $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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications at standard pharmacies and through standard mail order. For Tier 3 (Preferred Brand) drugs, standard pharmacy copays are $20 for a one-month supply and $60 for a three-month supply, which drops to a $40 copay when using a three-month standard mail order. Tier 4 (Non-Preferred) drugs require a 35% coinsurance for both standard pharmacy and mail order fills, while Tier 5 (Specialty) drugs carry a 33% coinsurance for a one-month standard pharmacy supply. Tier 6 (Select Care) drugs have a $10 copay for a one-month supply at standard pharmacies and a $20 copay for a three-month supply through standard mail order. This cost-sharing structure helps beneficiaries easily estimate their out-of-pocket expenses when choosing the Advantage Care by Ultimate (HMO C-SNP) plan.
Additional Benefits
Advantage Care by Ultimate (HMO C-SNP) offers comprehensive medical coverage featuring no copays for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a $60 daily copay for days one through five and no copay for days six through 90. Specialist visits and physical therapies require a low $3 copay, while emergency room visits carry a $120 copay with no coinsurance. This plan also provides excellent supplemental benefits, including no copays or coinsurance for routine dental cleanings, annual vision and hearing exams, and select diabetic equipment. Members receive up to $110 monthly for over-the-counter items, up to $400 annually for eyewear, and up to $1,000 per ear annually for prescription hearing aids. Additionally, diagnostic lab services, outpatient x-rays, and unlimited transportation to plan-approved locations are covered with no copay or coinsurance.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $60 daily copay for days 1 to 5 and no copay for days 6 to 90. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Advantage Care by Ultimate (HMO C-SNP) with no coinsurance, featuring copays of $75 to $150 for hospital outpatient visits and $150 per stay for observation services. Ambulatory surgical center services require a $25 copay with no coinsurance, while outpatient substance abuse sessions have a $10 to $20 copay and outpatient blood services have no copay or coinsurance.
Partial Hospitalization See details
Advantage Care by Ultimate (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Advantage Care 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 is partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Advantage Care by Ultimate (HMO C-SNP) covers emergency services with a $120 copay and urgently needed services with a $10 copay, both featuring no coinsurance and waived fees if admitted within 24 hours. Worldwide emergency services are partially covered up to a $50,000 limit with a $100 copay and no coinsurance, though worldwide urgent care and emergency transportation are not covered.
Primary Care See details
Advantage Care by Ultimate (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, speech, and mental health therapies are covered with a $3 copay and no coinsurance. Opioid treatment services are available with no copay and a 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for covered care, though some services require referrals or prior authorization. While services like kidney disease education, diabetes training, and fitness benefits are covered, others such as annual physical exams, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered exams and prescription hearing aids. This benefit includes one routine exam and one fitting evaluation annually, plus up to $1,000 per ear per year for prescription hearing aids, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision Services are partially covered by Advantage Care by Ultimate (HMO C-SNP), as other eye exam services are not covered. Routine eye exams are covered once annually with no copay and no coinsurance, while eyewear is covered with no coinsurance up to a $400 annual maximum, with copays applying only to Medicare-covered eyewear and upgrades ranging from $30 to $50.
Dental Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers dental services with no copay and no coinsurance for covered services, including exams, cleanings, fluoride, x-rays, restorative care, endodontics, periodontics, and oral surgery. Sub-services that are not covered under this plan include other diagnostic services, other preventive services, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Advantage Care by Ultimate (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Medical equipment is covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and a 20% coinsurance for durable medical equipment and prosthetics, requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Advantage Care by Ultimate (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals for all services. Lab services and outpatient X-rays have no copay and no coinsurance, diagnostic tests carry a copay of $0 to $150 with coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Advantage Care 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 offered by Advantage Care by Ultimate (HMO C-SNP) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Advantage Care by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 to 20 and days 39 to 100, while days 21 to 38 require a $150 daily copay, with prior authorization and referrals required.
Other Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers other services, offering a chronic illness meal benefit and up to $110 per month for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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