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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 Lake, Marion, and Sumter 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 $2400.00 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 drug coverage begins immediately. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, there is no copay for 1-month or 3-month supplies at standard pharmacies, and no copay for a 3-month supply through standard mail order. This ensures that many common prescriptions are available to plan members at no cost. For higher-tier medications, Tier 3 (Preferred Brand) drugs require a $20 copay for a 1-month standard retail supply or a discounted $40 copay for a 3-month mail order. Tier 6 (Select Care Drugs) has a $10 copay for 1-month standard retail and a $20 copay for a 3-month mail order, while Tier 4 (Non-Preferred) and Tier 5 (Specialty) drugs require 35% and 33% coinsurance, respectively. These clear cost-sharing tiers help you manage your healthcare budget effectively.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copays or coinsurance for primary care visits and many preventive services. For inpatient hospital stays, members pay a daily copay of $150 for the first five days and no copay for days six through ninety. Outpatient services and emergency care are also covered with affordable copays and no coinsurance, including a $120 copay for emergency room visits and a $10 copay for urgent care. This plan also includes valuable extra benefits, such as dental, vision, and hearing care with no copays or coinsurance for covered routine services. Members benefit from a $400 annual eyewear allowance, a $1,000 annual hearing aid allowance per ear, and unlimited transportation to plan-approved locations. Additionally, the plan provides a $105 monthly allowance for over-the-counter items and covered meal benefits with no copays.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, and upgrades or 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 a $0 to $150 copay for outpatient hospital services, a $150 copay per stay for observation services, and a $25 copay for ambulatory surgical center services. Outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse services are partially covered with a $20 copay for individual sessions and group sessions not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Advantage Care by Ultimate (HMO C-SNP) 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 by Ultimate (HMO C-SNP), with ground ambulance services requiring a $200 copay and air ambulance services requiring a 20% coinsurance. Unlimited transportation to plan-approved health-related locations is covered with no copay and no coinsurance, while transportation to any other health-related location is 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 copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care by Ultimate (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and mental health sessions require a $3 copay and no coinsurance. Opioid treatment is covered with no copay and a 20% coinsurance, but podiatry services are not covered, and chiropractic benefits are only partially covered since routine and other chiropractic services are excluded.
Preventive Services See details
Preventive Services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered services, though referrals or prior authorization may be required for some benefits. While services like health education, memory fitness, and kidney disease education are included, several options such as annual physical exams, personal emergency response systems (PERS), weight management programs, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to $1,000 per ear every year. However, this benefit is only partially covered, as OTC hearing aids along with inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no deductibles, offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $400 annual limit with no coinsurance, featuring no copay for standard lenses, frames, or contacts, and a $30 to $50 copay for upgrades.
Dental Services See details
Dental Services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered services. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, 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. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Advantage Care by Ultimate (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Advantage Care by Ultimate (HMO C-SNP) partially covers medical equipment with no copays, requiring a 10% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. While diabetic equipment is covered with no copay or coinsurance, diabetic supplies and 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 authorizations and referrals for all services. Lab services feature no copay and no coinsurance, diagnostic procedures and tests require a $0 to $150 copay with coinsurance, and therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Advantage Care by Ultimate (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
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, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Advantage Care by Ultimate (HMO C-SNP) with no coinsurance, offering no copay for days 1 to 20 and days 39 to 100, and a $150 daily copay for days 21 to 38. Prior authorization and referrals are required, but a 3-day prior inpatient hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Advantage Care by Ultimate (HMO C-SNP), which offers no copay and no coinsurance for meal benefits and over-the-counter (OTC) items. Covered OTC items are reimbursed up to $105 monthly, while acupuncture is not covered under this plan.
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