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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 2026, 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 2026.
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 $4.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.10. 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 a $615.00 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 features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs when using standard pharmacies or standard mail order. This coverage applies to both one-month and three-month supplies, making it highly affordable to fill your common prescriptions. For other drug tiers, the plan requires a 25% coinsurance. This 25% coinsurance applies to Tier 3 preferred brand drugs and Tier 4 non-preferred drugs for both one-month and three-month supplies, as well as Tier 5 specialty drugs for a one-month supply. Understanding these copay and coinsurance levels can help you accurately budget your annual health care expenses.
Additional Benefits
The Advantage Plus by Ultimate (Full) (HMO D-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for most essential medical services. Members can access inpatient and outpatient hospital care, primary and specialist visits, emergency services, and preventive care at no cost. Additionally, home health, skilled nursing facility stays, and dialysis are covered with no copay, though some services require prior authorization or referrals. This plan also features robust supplemental benefits, including no-copay routine dental, vision, and hearing care, with allowances up to $500 for eyewear and $1,000 per ear annually for prescription hearing aids. Members also benefit from unlimited transportation to plan-approved locations and a monthly allowance of up to $205 for over-the-counter items with no copay or coinsurance. While many key services are covered at no cost, certain exclusions apply to specialized treatments, medical supplies, and non-Medicare-covered days.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP), providing acute and psychiatric hospital stays with no copay and no coinsurance. However, additional days, non-Medicare-covered stays, and acute care upgrades are not covered under this plan.
Outpatient Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. For outpatient substance abuse services, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by Advantage Plus by Ultimate (Full) (HMO D-SNP), where transportation is partially covered with no copay and no coinsurance for unlimited one-way rides to plan-approved locations, but trips to any health-related location are excluded. For ambulance benefits, some services are covered but ground and air ambulance services are not covered.
Emergency Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit with a $100 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) offers primary care, specialist, physical and occupational therapy, and telehealth benefits with no copay and no coinsurance. While some services are covered under chiropractic, mental health, and psychiatric benefits, routine and other chiropractic care, individual and group mental health or psychiatric sessions, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance, although some services require a referral or prior authorization. Covered offerings include kidney disease education and fitness benefits, while sub-services such as annual physical exams, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 maximum per ear every year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. The plan covers one routine eye exam and up to $500 in eyewear, including contact lenses or eyeglasses, every year.
Dental Services See details
Dental Services are partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive care. Excluded from coverage are other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) partially covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs are covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Medical equipment is partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While durable medical equipment is covered under these terms, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Advantage Plus by Ultimate (Full) (HMO D-SNP), offering lab services with no copay and no coinsurance. Other services, including diagnostic procedures and tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are not covered.
Home Health Services See details
Home Health Services are covered by Advantage Plus by Ultimate (Full) (HMO D-SNP) with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and no coinsurance, meaning some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. The plan waives the standard three-day prior hospital stay requirement, but additional days beyond Medicare-covered days are not covered.
Other Services See details
Advantage Plus by Ultimate (Full) (HMO D-SNP) partially covers other services, offering a chronic illness meal benefit and up to $205 monthly for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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