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Advantage Plus by Ultimate (Partial) (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Plus by Ultimate (Partial) (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 (Partial) (HMO D-SNP) in 2025, please refer to our full plan details page.
Advantage Plus by Ultimate (Partial) (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 (Partial) (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 (Partial) (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 (Partial) (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 (Partial) (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 (Partial) (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for most drugs at a standard pharmacy. Once you reach the catastrophic coverage phase, you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan offers coverage for a wide range of services, including inpatient and outpatient services, emergency care, primary care, preventive services, and home health services. Many services, such as ambulance, emergency services, and lab services, come with no copay or coinsurance, helping to keep your costs low. This plan also includes benefits for hearing, vision, dental, and other services, with specific allowances for hearing aids, eyewear, and dental care. This plan also offers additional benefits such as home infusion bundled services, dialysis services, medical equipment, and diagnostic and radiological services. There is a monthly allowance for over-the-counter (OTC) items. Some services require prior authorization or a doctor's referral, so it's important to understand those requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Prior authorization and a doctor's referral are required.
Outpatient Services See details
Outpatient Services are covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP), including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. However, individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP), but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Advantage Plus by Ultimate (Partial) (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.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have no copay or coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic Services are covered, except for routine chiropractic care, and podiatry services are not covered. Occupational therapy and physical therapy services have no copay or coinsurance, but require authorization and a referral.
Preventive Services See details
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, additional preventive services, kidney disease education, and other preventive services. However, annual physical exams, in-home safety assessments, personal emergency response systems, post discharge in-home medication reconciliation, re-admission 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, and counseling services are not covered. Additional services covered include health education, in-home support services, additional sessions for smoking cessation, fitness benefits, remote access technologies, and home and bathroom safety devices.
Hearing Services See details
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan covers hearing exams, routine hearing exams (1 every year), and fitting/evaluation for hearing aids (1 every year). The plan also covers prescription hearing aids (all types), with a maximum benefit of $1,000 per year, but does not cover inner ear, outer ear, or over the ear prescription hearing aids, or OTC hearing aids.
Vision Services See details
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $500 per year. This plan also covers one pair of contact lenses, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one eyeglass frame per year.
Dental Services See details
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and orthodontic services. Oral exams and dental x-rays each have a limit of 2 per year, prophylaxis and fluoride treatment each have a limit of 1 every six months, and some services require prior authorization. Maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered, with prior authorization and a doctor referral required. You may pay between 0% and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP), but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. For the covered services, there is no copay or coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance up to 20%, and Lab Services with no copay, as well as Therapeutic Radiological Services with a coinsurance up to 20%. Diagnostic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor's referral are required.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $125.00 per month, and a meal benefit for a chronic illness, but acupuncture, 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 are not covered.
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