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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 Manatee and Sarasota 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 $174.70. 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 has a $0 deductible. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay no copay for preferred generic drugs, a $25 copay for standard generic drugs, and a $75 copay for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Premier by Ultimate (HMO) plan provides coverage for a wide range of services, including inpatient hospital stays with a copay, outpatient services, emergency services, primary care, preventive services, and vision services. This plan also offers coverage for hearing exams, dental services, and home health services. This plan includes copays for various services, such as outpatient services, specialist visits, and ambulance services. Many preventive services are covered with no copay, and prescription hearing aids are covered up to a certain annual limit.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered with a $175 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services for Premier by Ultimate (HMO) includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $150 copay, while ambulatory surgical center services have a $25 copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Premier by Ultimate (HMO) plan, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Premier by Ultimate (HMO) plan. 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 12 one-way trips per year. Transportation Services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered. For Emergency Services, there is a $75 copay and no coinsurance, and for Urgently Needed Services, there is a $10 copay and no coinsurance. Worldwide Emergency Coverage is covered with a $100 copay and no coinsurance, but 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 and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, physician specialist services have a $25 copay, occupational therapy services have a $30 copay, individual and group mental health and psychiatric sessions have copays of $25 and $10 respectively, physical therapy and speech-language pathology services have a $30 copay, and opioid treatment program services have a 20% coinsurance. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, and additional services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
The Premier by Ultimate (HMO) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with 1 visit per year. Prescription hearing aids (all types) are covered with a maximum benefit of $1,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Premier by Ultimate (HMO) plan covers vision services, including routine eye exams, with no copay. Eyewear is covered with a copay for Medicare-covered benefits, and has a combined maximum benefit of $300 per year. Contact lenses are covered, and upgrades have a copay of $30-$50.
Dental Services See details
The Premier by Ultimate (HMO) plan covers dental services, including oral exams with 2 visits, dental x-rays with 2 visits, prophylaxis (cleaning) with 1 visit, and fluoride treatment with 1 visit. Orthodontic services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Premier by Ultimate (HMO), and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Premier by Ultimate (HMO) plan and require prior authorization and a doctor referral. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, as well as Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance, and Diabetic Equipment. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay of up to $150 and a coinsurance of up to 20%, while Lab Services have no copay and a coinsurance of up to 20%. Diagnostic Radiological Services have a copay of up to $150, and Therapeutic Radiological Services have a coinsurance of up to 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 additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Premier by Ultimate (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Premier by Ultimate (HMO) plan with a doctor referral and prior authorization. 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services are covered, but 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 are not covered. The plan does offer a meal benefit for chronic illnesses.
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