A non-government entity
Premier by Ultimate (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Premier by Ultimate (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Premier by Ultimate (HMO) in 2025, please refer to our full plan details page.
Premier by Ultimate (HMO) is a HMO plan offered by Ultimate Healthcare Holdings, LLC available for enrollment in 2025 to people living in Lake, Marion, and Sumter counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Premier by Ultimate (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Premier by Ultimate (HMO).
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 Premier by Ultimate (HMO), 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 $174.00. 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 $2500.00 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:
Sign up for Premier by Ultimate (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Premier by Ultimate (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, and $35 for standard generic drugs. Preferred brand drugs have a $85 copay. Non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Premier by Ultimate (HMO) offers a variety of health benefits, including inpatient and outpatient hospital services, with copays varying by service. The plan covers primary care, preventive services, hearing, vision, and dental services, with specific copays and annual maximums for some benefits. Additional benefits include ambulance and transportation services, emergency services, and home health services with no copay. However, some services like cardiac rehabilitation, certain dental procedures, and other services such as acupuncture are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by Premier by Ultimate (HMO). For days 1-5, there is a $170 copay, and for days 6-90, there is no copay.
Outpatient Services See details
The Premier by Ultimate (HMO) plan covers outpatient services including outpatient hospital services with a copay between $75 and $150, observation services with a $150 copay, ambulatory surgical center services with a $25 copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services. All services require prior authorization and a doctor's referral.
Partial Hospitalization See details
Partial Hospitalization is covered under the Premier by Ultimate (HMO) plan, requiring prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Premier by Ultimate (HMO). Ground ambulance services have a $150 copay, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under Premier by Ultimate (HMO). Emergency Services has a $75 copay, Urgently Needed Services has a $10 copay, and Worldwide Emergency Coverage has a $100 copay, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Premier by Ultimate (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, physician specialist services, mental health specialty services, physical therapy and speech-language pathology services have a $20 copay, and the opioid treatment program services have a 20% coinsurance. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit (Memory Fitness), 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 Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Prescription hearing aids (all types) are covered with a plan maximum benefit of $1000.00 per year, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Premier by Ultimate (HMO) plan covers vision services, including routine eye exams with 1 visit every year, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $300 per year, and upgrades have a copay of $30-$50.
Dental Services See details
The Premier by Ultimate (HMO) plan covers oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, orthodontic services, restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery. Endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Premier by Ultimate (HMO), including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Premier by Ultimate (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit also with a 20% coinsurance; Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $25 and $150, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay between $25 and $150, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Premier by Ultimate (HMO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under Premier by Ultimate (HMO), but require prior authorization and a doctor's referral. You will have no copay for days 1-20 and days 41-100, but a $150 copay for days 21-40. Additional days beyond Medicare coverage, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for Premier by Ultimate (HMO) are not covered, including 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. However, a meal benefit is offered for chronic illnesses.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved