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Advantage Plus by Ultimate (Full) (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Plus by Ultimate (Full) (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Advantage Plus by Ultimate (Full) (HMO D-SNP) in 2025, please refer to our full plan details page.
Advantage Plus by Ultimate (Full) (HMO D-SNP) is a HMO D-SNP plan offered by Ultimate Healthcare Holdings, LLC available for enrollment in 2025 to people living in All Service Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Advantage Plus by Ultimate (Full) (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Advantage Plus by Ultimate (Full) (HMO D-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 Plus by Ultimate (Full) (HMO D-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 Plus by Ultimate (Full) (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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 Plus by Ultimate (Full) (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for generic and brand-name drugs at standard pharmacies. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay $20.30.
Additional Benefits
The Advantage Plus by Ultimate (Full) (HMO D-SNP) plan offers coverage for a wide range of services. It includes coverage for inpatient and outpatient services, primary care, preventive services, hearing, vision, dental, and home health services. Many services, such as ambulance, emergency, vision, and home health, have no copay, but prior authorization or doctor referrals may be required. This plan also provides additional benefits like over-the-counter items with a monthly allowance and a meal benefit for chronic illnesses. Diagnostic and radiological services, as well as cardiac rehabilitation services, have limited coverage. There is also coverage for hearing aids and prescription hearing aids, and a yearly maximum benefit for eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered stays for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional days for Inpatient Hospital Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Advantage Plus by Ultimate (Full) (HMO D-SNP) plan. All Ambulance Services are covered with no copay or coinsurance, but Ground and Air Ambulance Services are not covered; Transportation Services to a plan-approved health-related location are covered, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including emergency and urgently needed services with no copay or coinsurance, and worldwide emergency services. Worldwide emergency coverage has a $100 copay, while worldwide urgent coverage and worldwide emergency transportation are not covered. Worldwide emergency services have a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay and no coinsurance, while Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered.
Preventive Services See details
The Advantage Plus by Ultimate (Full) (HMO D-SNP) plan covers several preventive services, including Medicare-covered services with no copay, health education, medical nutrition therapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, 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. The plan does not cover annual physical exams, in-home safety assessments, personal emergency response systems, 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, support for caregivers of enrollees, enhanced disease management, telemonitoring services, and counseling services.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids, each with one visit per year, and prescription hearing aids with a maximum benefit of $1,000 per year. Prescription hearing aids include two visits per year, but prescription hearing aids for the inner ear, outer ear, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Advantage Plus by Ultimate (Full) (HMO D-SNP) plan covers vision services, including routine eye exams with one visit per year, eyewear with a combined maximum benefit of $500 per year, contact lenses with one pair per year, eyeglasses (lenses and frames) with one pair per year, eyeglass lenses with one pair per year, eyeglass frames with one frame per year, and upgrades. There is no copay or coinsurance for any of these services.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, and oral and maxillofacial surgery. This plan does not cover maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Advantage Plus by Ultimate (Full) (HMO D-SNP) plan, and require prior authorization. The plan covers Medicare Part B Insulin Drugs, but does not cover Medicare Part B Chemotherapy/Radiation Drugs.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The plan does not specify any cost-sharing information.
Medical Equipment See details
Medical Equipment benefits are covered by Advantage Plus by Ultimate (Full) (HMO D-SNP). Durable Medical Equipment (DME) and Prosthetics/Medical Supplies have no copay or coinsurance, but require authorization, while Diabetic Equipment is partially covered, with Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP), with Lab Services covered with no copay, while Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Advantage Plus by Ultimate (Full) (HMO D-SNP) plan with no copay or coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice because Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required for SNF services.
Other Services See details
The Advantage Plus by Ultimate (Full) (HMO D-SNP) plan does not cover acupuncture, 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. The plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $125.00 every month, and a meal benefit for a chronic illness.
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