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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 Indian River and St. Lucie 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 $2800.00 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) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a 1-month or 3-month supply at standard pharmacies, and no copay for a 3-month standard mail order. This makes managing common generic medications highly affordable with zero out-of-pocket costs. Tier 3 preferred brand drugs cost a $30 copay for a 1-month standard pharmacy supply, or a $60 copay for a 3-month standard mail order. Select Care Drugs under Tier 6 require a $10 copay for a 1-month supply or a $20 copay for a 3-month mail order. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance.
Additional Benefits
Advantage Care by Ultimate (HMO C-SNP) offers affordable healthcare coverage with no copay or coinsurance for primary care doctor visits, preventive services, and home health care. For inpatient hospital stays, members pay a $195 daily copay for the first five days and no copay for days six through 90. Emergency room visits carry a $120 copay, while specialist visits and urgent care services require low copays of just $8 and $10, respectively. This plan also features robust supplemental benefits, including no copay or coinsurance for routine dental, vision, and hearing exams, alongside generous allowances for eyewear and hearing aids. Members receive unlimited rides to approved health-related locations and a $115 monthly over-the-counter allowance with no copay or coinsurance. For specialized medical needs, diagnostic lab tests have no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Advantage Care by Ultimate (HMO C-SNP) with no coinsurance, featuring a $195 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as non-Medicare-covered stays and upgrades are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Advantage Care by Ultimate (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $75 to $150 copay for outpatient hospital visits, a $150 copay per stay for observation services, and a $50 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 individual or $15 group session copay with no coinsurance, while outpatient blood services are covered with no copay and no 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 for some of these covered services.
Ambulance and Transportation Services See details
Advantage Care by Ultimate (HMO C-SNP) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any 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 with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 lifetime limit with a $100 copay and no coinsurance, though worldwide urgent care 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 specialists, therapy services, and mental health visits require an $8 copay and no coinsurance. Opioid treatment is covered with no copay and 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance, though prior authorization or referrals may be required for some benefits. Covered services include Medicare-covered preventive care, kidney disease education, and fitness programs. Services that are not covered include annual physical exams, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Advantage Care by Ultimate (HMO C-SNP) covers hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear annually, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Advantage Care by Ultimate (HMO C-SNP), offering one routine eye exam per year with no copay or coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $300 annual maximum with no coinsurance for contacts or one pair of eyeglasses, though upgrades carry a $30 to $50 copay.
Dental Services See details
Advantage Care by Ultimate (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care. This plan does not cover other diagnostic services, other preventive services, implants, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics.
Home Infusion bundled Services See details
Advantage Care by Ultimate (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while 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 by Ultimate (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by Advantage Care by Ultimate (HMO C-SNP), with durable medical equipment and prosthetics requiring no copay and a 20% coinsurance. While diabetic equipment features no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this benefit.
Diagnostic and Radiological Services See details
Advantage Care by Ultimate (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization and referrals. Lab services have no copay or coinsurance, diagnostic tests require coinsurance and a copay of $0 to $150, and therapeutic radiology requires a copay and 20% coinsurance, while outpatient X-rays and diagnostic radiology feature no copays.
Home Health Services See details
Home Health Services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance. This benefit requires prior authorization and a referral before services can be received.
Cardiac Rehabilitation Services See details
Advantage Care by Ultimate (HMO C-SNP) covers cardiac rehabilitation services with no coinsurance and a $10 copay, subject to prior authorization. Although the benefit is technically active, only some services are covered in practice, as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Advantage Care by Ultimate (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and days 39 through 100, and a $150 daily copay for days 21 through 38. Prior authorization and referrals are required for this benefit, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Advantage Care by Ultimate (HMO C-SNP) partially covers other services, offering a meal benefit for chronic illness and over-the-counter (OTC) items up to $115 per month with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered under this plan.
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