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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 2025, 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 2025.
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 $170.00. 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) plan has an enhanced alternative drug benefit. The plan has a $0 deductible, meaning you pay nothing before your drug coverage begins. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, $30 for standard generic drugs, and $70 for preferred brand drugs. For non-preferred drugs, you pay 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Premier by Ultimate (HMO) plan offers comprehensive coverage, including inpatient and outpatient services, with varying copays. Inpatient hospital stays have a $90 copay for days 1-5 and no copay for days 6-90, while outpatient services have copays ranging from $15 to $150 depending on the service. Emergency services have a $75 copay. This plan also includes coverage for primary care, preventive services, hearing, vision, and dental services. Hearing aids are covered up to $1000 annually, and vision includes eye exams and eyewear benefits. Dental services cover oral exams, x-rays, and cleaning. Additional benefits include ambulance and transportation services, with a $150 copay for ground ambulance, as well as home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including services not usually covered by Medicare plans, are covered with a $90 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered, with 1 additional day per benefit period. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Premier by Ultimate (HMO) plan covers outpatient services, including outpatient hospital services with a copay of $75-$150, observation services with a $150 copay, ambulatory surgical center services with a $25 copay, outpatient substance abuse services with a $15 copay for individual or group sessions, and outpatient blood services. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Premier by Ultimate (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under Premier by Ultimate (HMO), with copays of $75, $10, and $100 respectively, and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Premier by Ultimate (HMO) plan covers primary care physician services, chiropractic 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 have a $15 copay, and occupational therapy services have a $15 copay. Physician specialist services, physical therapy, and speech-language pathology services all have a $15 copay. Mental health and psychiatric services have a copay of $15 for individual sessions and $10 for group sessions. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered, with services such as annual physical exams, in-home safety assessments, and counseling services not covered. Other covered services include health education, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs.
Hearing Services See details
Hearing exams and prescription hearing aids are covered under the Premier by Ultimate (HMO) plan, with a maximum of $1000 per year for prescription hearing aids, while routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services include coverage for eye exams with no deductible, and routine eye exams are covered once per year. Eyewear benefits, including contact lenses, eyeglasses, and upgrades are covered, with contact lenses having unlimited coverage, eyeglasses (lenses and frames) covered once per year, and upgrades with a copay of $30-$50.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery. Endodontics, prosthodontics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Premier by Ultimate (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Premier by Ultimate (HMO) plan, but require prior authorization and a doctor's referral. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, Prosthetic Devices and Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a limit to specified manufacturers, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $25 and $150, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay between $25 and $150, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Premier by Ultimate (HMO), with no copay and no 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 not covered by the Premier by Ultimate (HMO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Premier by Ultimate (HMO), but require prior authorization and a doctor's referral. For days 1-20, there is no copay, for days 21-40 the copay is $150, and for days 41-100, there is no copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services are generally not covered by Premier by Ultimate (HMO), with no coverage for acupuncture, over-the-counter items, 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 does cover a meal benefit for a chronic illness.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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