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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 Orange, Osceola and Seminole 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 $2900.00 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs at standard pharmacies for both 1-month and 3-month supplies, as well as for 3-month standard mail orders. This offers significant savings on common medications. For Tier 3 preferred brand drugs, you will pay a $30 copay for a 1-month supply and a $90 copay for a 3-month supply at standard pharmacies, which drops to a $60 copay for a 3-month standard mail order. Higher-tier prescriptions, such as Tier 4 non-preferred drugs, carry a 35% coinsurance, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month standard pharmacy supply.
Additional Benefits
The Premier by Ultimate (HMO) plan delivers comprehensive medical coverage with no copay for primary care visits, preventive services, home health care, and laboratory tests. Specialist consultations and urgent care services require a low $10 copay, while outpatient hospital visits have a $195 copay. For inpatient hospital stays, members pay a $175 daily copay for the first five days and no copay for days six through 90. This plan also includes extensive supplemental perks, featuring no copay for routine dental, vision, and hearing exams, as well as allowances for eyewear and hearing aids. Additionally, members receive up to 12 free one-way transportation trips annually and a $95 monthly reimbursement for over-the-counter items. Durable medical equipment, dialysis, and therapeutic radiology services require no copay and a 20% coinsurance.
Inpatient Hospital See details
Premier by Ultimate (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Premier by Ultimate (HMO) covers outpatient services with no coinsurance, including a $195 copay for outpatient hospital and observation services, and a $50 copay for ambulatory surgical center services. Outpatient substance abuse sessions carry a $10 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Premier by Ultimate (HMO) with a $55.00 copay and no coinsurance. This benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Premier by Ultimate (HMO) covers ground ambulance services with a $200 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Premier by Ultimate (HMO) covers emergency services with a $120 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Premier by Ultimate (HMO) provides primary care, physical therapy, and speech-language services with no copay and no coinsurance, while specialist, occupational therapy, mental health, and psychiatric services require a $10 copay and no coinsurance. Opioid treatment is covered with no copay and a 20% coinsurance, podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic 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 referrals or prior authorization may be required for some services. Covered benefits include Medicare-covered preventive care, kidney disease education, and health education, while annual physical exams, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance, including one routine exam and one fitting evaluation per year. Prescription hearing aids are also covered up to $1,000 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Premier by Ultimate (HMO) partially covers vision services, offering one routine eye exam yearly with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $400 annual maximum with no coinsurance, though upgrades require a $30 to $50 copay and Medicare-covered eyewear requires a copay.
Dental Services See details
Premier by Ultimate (HMO) partially covers dental services with no copay and no coinsurance for covered benefits, though prior authorization is required for select treatments. Non-covered services under this plan include endodontics, fixed and removable prosthodontics, implants, orthodontics, other diagnostic, and other preventive dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Premier by Ultimate (HMO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs feature no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Premier by Ultimate (HMO) covers dialysis services with no copay and a 20% coinsurance. Both prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Premier by Ultimate (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially 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
Premier by Ultimate (HMO) covers diagnostic and radiological services, requiring referrals and prior authorization for all care. Lab services feature no copay and no coinsurance, diagnostic tests have no coinsurance and copays up to $195, and outpatient X-rays have no copay. Diagnostic radiological services require copays starting at $25 with no coinsurance, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Premier by Ultimate (HMO) plan with no copay and no coinsurance, though a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Premier by Ultimate (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Premier by Ultimate (HMO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and days 41 through 100, and a $150 copay for days 21 through 40. Prior authorization and referrals are required, but a prior three-day inpatient hospital stay is not needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Premier by Ultimate (HMO) provides partial coverage for other services, which include over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, though acupuncture is not covered. Eligible members receive up to $95 monthly in reimbursement for over-the-counter items.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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