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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 2026, 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 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.40. 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 (Partial) (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. This plan offers savings on lower-tier medications, featuring no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 supplemental drugs at standard pharmacies and standard mail order. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance at standard pharmacies. This 25% coinsurance also applies to three-month supplies of Tier 3 and Tier 4 medications filled through standard mail order.
Additional Benefits
The Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for most essential services, including inpatient hospital stays, primary and specialist visits, and outpatient care. Members can also access preventive services, skilled nursing, and home health care at no cost, though some benefits require prior authorization or referrals. Additionally, the plan provides valuable extra benefits with no copays, including up to $210 monthly for over-the-counter items, $500 annually for eyewear, and up to $1,000 per ear annually for prescription hearing aids. While most covered services have no out-of-pocket costs, exceptions include a $100 copay for worldwide emergency care, copayments for diagnostic procedures, and up to 20% coinsurance for dialysis.
Inpatient Hospital See details
Advantage Plus by Ultimate (Partial) (HMO D-SNP) offers partially covered inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization and referrals are required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and outpatient blood services. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Advantage Plus by Ultimate (Partial) (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance. Unlimited one-way transportation to plan-approved locations is covered, but transportation to any health-related location, ground ambulance, and air ambulance services are not covered.
Emergency Services See details
Emergency Services are covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance for domestic emergency and urgently needed services. Worldwide emergency services are partially covered up to a $50,000 lifetime maximum with a $100 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under Advantage Plus by Ultimate (Partial) (HMO D-SNP) are covered with no copay and no coinsurance for primary care physician, specialist, therapy, telehealth, and opioid treatment services. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care, along with individual and group mental health and psychiatric sessions, are not covered.
Preventive Services See details
Preventive Services are partially covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance, though prior authorization or referrals are required for some benefits. Covered services include Medicare-covered preventive services, kidney disease education, and health education, while annual physical exams, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Advantage Plus by Ultimate (Partial) (HMO D-SNP) provides partially covered hearing services, offering routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay and no coinsurance, though 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 Plus by Ultimate (Partial) (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam per year and up to $500 annually for eyewear, while other eye exam services are not covered.
Dental Services See details
Advantage Plus by Ultimate (Partial) (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for covered care. Services that are not covered include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs are covered with no copay and no coinsurance, but 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 (Partial) (HMO D-SNP) with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Medical Equipment is covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance, with prior authorization required for durable medical equipment. While some prosthetic and diabetic equipment services are covered, 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 (Partial) (HMO D-SNP), requiring prior authorization and referrals. Covered diagnostic procedures and tests require a copayment with no coinsurance, while lab and therapeutic radiological services feature no copay or coinsurance; however, diagnostic radiological services and outpatient x-rays are not covered.
Home Health Services See details
Advantage Plus by Ultimate (Partial) (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Advantage Plus by Ultimate (Partial) (HMO D-SNP) plan with no copay and no coinsurance, subject to prior authorization. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP) with no copay and no coinsurance, though prior authorization and referrals are required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond those covered by Medicare are not covered.
Other Services See details
Other services are partially covered by Advantage Plus by Ultimate (Partial) (HMO D-SNP), which offers a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. While members receive up to $210 monthly in OTC reimbursements, acupuncture is not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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