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Premier by Ultimate (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Premier by Ultimate (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Premier by Ultimate (HMO) in 2026, please refer to our full plan details page.
Premier by Ultimate (HMO) is a HMO plan offered by Ultimate Healthcare Holdings, LLC available for enrollment in 2025 to people living in Hillsborough, Pinellas and Polk counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Premier by Ultimate (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Premier by Ultimate (HMO).
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 Premier by Ultimate (HMO), 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 $185.00. 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 $1900.00 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 Premier by Ultimate (HMO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage starts immediately without any out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for both one-month and three-month supplies at standard pharmacies and via standard mail order. This plan provides affordable access to essential medications right from the start of your coverage. For Tier 3 preferred brand drugs, standard pharmacy copays are $30 for a one-month supply and $90 for a three-month supply, though you can save with a $60 copay for a three-month standard mail order. Tier 4 non-preferred drugs require a 35% coinsurance for both one-month and three-month supplies, while Tier 5 specialty medications require a 33% coinsurance for a one-month supply. This clear structure helps you easily estimate your annual out-of-pocket drug costs.
Additional Benefits
The Premier by Ultimate (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copays for primary care visits, physical therapy, and home health services. Specialist visits and mental health services require a low $10 copay, while inpatient hospital stays cost $90 per day for the first five days with no copay for subsequent days. Emergency room visits carry a $120 copay, and urgently needed services are available for a $10 copay, with coinsurance waived for both. In addition to medical care, the plan provides excellent routine dental, vision, and hearing benefits with no copays, including allowances of up to $1,000 per ear for hearing aids and $400 annually for eyewear. Members also receive up to 20 free one-way trips to approved health locations and a $90 monthly allowance for over-the-counter items. Skilled nursing facility stays are also covered with no copay for days 1 through 20 and days 41 through 100.
Inpatient Hospital See details
Premier by Ultimate (HMO) partially covers inpatient hospital services, including acute and psychiatric care, with no coinsurance and a copay of $90 per day for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization and referrals are required, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Premier by Ultimate (HMO) covers outpatient services with no coinsurance, featuring copays of $75 to $150 for outpatient hospital services, $150 for observation services, and $25 for ambulatory surgical center services. Outpatient substance abuse sessions require a $15 copay, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Premier by Ultimate (HMO) with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Premier by Ultimate (HMO) covers ambulance services with a $200 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport, both of which require prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 20 one-way trips per year to plan-approved health-related locations, though trips to non-approved health-related locations are not covered.
Emergency Services See details
Premier by Ultimate (HMO) covers emergency services with a $120 copay and urgently needed services with a $10 copay, both featuring no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 lifetime maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits covered by Premier by Ultimate (HMO) include primary care, physical therapy, and speech-language services with no copay and no coinsurance. Specialist visits, occupational therapy, and mental health services require a $10 copay and no coinsurance, while opioid treatment has no copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Premier by Ultimate (HMO) with no copay and no coinsurance, though some services require referrals or prior authorization. Covered services include Medicare-covered zero-dollar preventive care and kidney disease education, while an annual physical exam, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are partially covered by Premier by Ultimate (HMO) with no copay and no coinsurance, including one annual routine exam and fitting evaluation. Prescription hearing aids are covered up to $1,000 per ear yearly with no copay or coinsurance, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Premier by Ultimate (HMO), featuring one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no coinsurance up to a $400 annual limit, with copays ranging from $30 to $50 for upgrades.
Dental Services See details
Premier by Ultimate (HMO) partially covers dental services with no copay and no coinsurance for covered benefits like oral exams, cleanings, dental x-rays, and select restorative, periodontal, and oral surgery services. However, other diagnostic and preventive services, endodontics, prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Premier by Ultimate (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance of 0% to 20%.
Dialysis Services See details
Premier by Ultimate (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Premier by Ultimate (HMO) partially covers medical equipment, providing durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services covered under Premier by Ultimate (HMO) require referrals and prior authorization, featuring lab services with no copay or coinsurance and outpatient x-rays with no copay but subject to coinsurance. Diagnostic procedures carry a $25 to $150 copay with coinsurance, diagnostic radiological services require a copay starting at $25, and therapeutic radiological services incur a 20% coinsurance plus a copay.
Home Health Services See details
Home health services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Premier by Ultimate (HMO) with no coinsurance and require prior authorization. While some services are covered, key sub-services including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Premier by Ultimate (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and 41 to 100, and a $150 daily copay for days 21 to 40. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Premier by Ultimate (HMO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides a maximum reimbursement of $90 per month, which does not carry over if unused.
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