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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 Indian River and St. Lucie 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 $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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy. You will pay a $30 copay for standard generic drugs, an $80 copay for preferred brand drugs, and a 33% coinsurance for non-preferred drugs at a standard pharmacy.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Primary care, specialist, and mental health visits have a $20 copay, while emergency services have a $60 copay. The plan also includes coverage for preventive, hearing, vision, dental, and home health services, with specific cost-sharing arrangements for each. This plan provides additional benefits such as ambulance services, with a $150 copay for ground transport and 20% coinsurance for air ambulance. There is coverage for home infusion services, dialysis, and medical equipment with a 20% coinsurance. Skilled nursing facilities have no copay for some days, but a $150 copay for others.
Inpatient Hospital See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers Inpatient Hospital services, including Acute and Psychiatric, with prior authorization and a doctor's referral required. For days 1-5, there is a $175 copay, and for days 6-90, there is no copay. Additional days for both Acute and Psychiatric are covered. Non-Medicare-covered stays and upgrades 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 $150 copay, ambulatory surgical center services with a $50 copay, outpatient substance abuse services, and outpatient blood services. Individual sessions for outpatient substance abuse have a copay of $30, and group sessions have a copay of $15.
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 this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Advantage Care by Ultimate (HMO C-SNP), including both ground and air ambulance services, as well as transportation to a plan-approved health-related location. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. 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 by the Advantage Care by Ultimate (HMO C-SNP) plan. Emergency Services has a $60 copay, Urgently Needed Services has a $10 copay, and Worldwide Emergency Coverage has a $100 copay. 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 services and specialist services with a $20 copay, and covers chiropractic services with a $20 copay for routine care. Occupational therapy has a $30 copay, while physical therapy and speech-language pathology services have a $30 copay. Mental health services have a copay of $20 for individual sessions and $10 for group sessions, and psychiatric services have a copay of $20 for individual sessions and $10 for group sessions. Opioid treatment program services are covered with 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, additional preventive services like health education, medical nutrition therapy, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, and other preventive services like 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 (PERS), post-discharge in-home medication reconciliation, readmission 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 include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year. Prescription hearing aids (all types) are covered for two visits per year with a maximum plan benefit of $1,000 per year, and prescription hearing aids for the inner, outer, and over the ear 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. Eyewear includes contact lenses, eyeglasses (lenses and frames) with one pair per year, eyeglass lenses with one pair per year, and eyeglass frames with one frame per year. Upgrades have a copay of $30 to $50.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. However, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered, and restorative services, endodontics, periodontics, and oral and maxillofacial surgery require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 by the Advantage Care by Ultimate (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Advantage Care by Ultimate, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and a coinsurance for Medicare-covered diagnostic procedures and tests. Lab services have no copay and a coinsurance of at most 20%, while diagnostic radiological services have a copay of at most $150, and therapeutic radiological services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Advantage Care by Ultimate (HMO C-SNP) plan with no copay and no coinsurance, but authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Advantage Care by Ultimate (HMO C-SNP), but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
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. There is no copay for days 1-20 and days 39-100, but there is a $150 copay for days 21-38, and there is no coinsurance.
Other Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan 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, or Self-Directed Personal Assistance Services. The plan covers a meal benefit for a chronic illness.
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