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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 Manatee and Sarasota 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 $3200.00 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 offers prescription drug coverage with a $0 drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month or 3-month supplies at standard pharmacies, nor for 3-month supplies ordered through standard mail order. This plan provides an affordable option for those utilizing common generic medications. For Tier 3 preferred brand drugs, standard pharmacy copays are $25 for a 1-month supply and $75 for a 3-month supply, with a 3-month standard mail order option costing a $50 copay. Higher-tier medications, such as Tier 4 non-preferred drugs, require a 35% coinsurance for both standard pharmacy and mail order fills. Tier 5 specialty drugs are subject to a 33% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
Premier by Ultimate (HMO) offers comprehensive coverage with predictable, low out-of-pocket costs, featuring no copay for primary care visits, physical therapy, and preventive services. For specialist visits and urgent care, members pay a low $10 copay, while inpatient hospital stays require a $175 daily copay for the first five days and no copay thereafter. Emergency room visits have a $120 copay, which is waived if you are admitted to the hospital within 24 hours. The plan also includes valuable supplemental benefits with no copay or coinsurance for routine dental, vision, and hearing exams, alongside a $1,000 annual hearing aid allowance per ear and a $300 annual eyewear limit. Additionally, members benefit from a $70 monthly over-the-counter allowance and no copay for home health services and the first 20 days of skilled nursing facility care. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Premier by Ultimate (HMO) 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, and additional hospital 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 outpatient hospital and observation services for a $150 copay, and ambulatory surgical center services for a $25 copay. Outpatient substance abuse sessions require a $30 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Premier by Ultimate (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
Premier by Ultimate (HMO) covers ambulance services with a $200 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, 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 admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 maximum benefit with a $100 copay and no coinsurance for emergency coverage, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Premier by Ultimate (HMO) covers primary care, physical therapy, and speech-language pathology 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 services are covered with no copay and a 20% coinsurance, but 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 referrals or prior authorizations may be required for certain services. Uncovered services under this benefit include the Annual Physical Exam, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Premier by Ultimate (HMO) covers hearing services with no copay and no coinsurance, which includes one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with a $1,000 maximum benefit per ear annually, though 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), as other eye exam services are not covered. Routine eye exams are available with no copay and no coinsurance, while covered eyewear has no coinsurance and a $300 annual limit, though copays of $30 to $50 apply to upgrades and Medicare-covered eyewear requires a copayment.
Dental Services See details
Dental services are partially covered by Premier by Ultimate (HMO) with no copay and no coinsurance for covered care such as oral exams, cleanings, x-rays, restorative services, periodontics, and oral surgery. However, other diagnostic and preventive services, endodontics, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Premier by Ultimate (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
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) offers partially covered medical equipment benefits, with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. 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
Premier by Ultimate (HMO) covers diagnostic and radiological services, requiring referrals and prior authorization for all services. Members pay no copay or coinsurance for lab services, no coinsurance and a copay ranging from no copay to $150 for diagnostic procedures, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the Premier by Ultimate (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Premier by Ultimate (HMO) with no copay, no coinsurance, and prior authorization required. While some services are covered, specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for symptomatic PAD rehabilitation, are not covered.
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 through 20 and days 41 through 100, and a $150 daily copay for days 21 through 40. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Premier by Ultimate (HMO) partially covers other services, offering chronic illness meal benefits and up to $70 monthly in over-the-counter (OTC) item reimbursements with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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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