A non-government entity
Advantage Care by Ultimate (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Care by Ultimate (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Advantage Care by Ultimate (HMO C-SNP) in 2026, please refer to our full plan details page.
Advantage Care by Ultimate (HMO C-SNP) is a HMO C-SNP 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 Advantage Care by Ultimate (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Advantage Care by Ultimate (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Advantage Care by Ultimate (HMO C-SNP).
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 Advantage Care by Ultimate (HMO C-SNP), 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:
Sign up for Advantage Care by Ultimate (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Advantage Care by Ultimate (HMO C-SNP) plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs at standard pharmacies or through standard mail order. This makes managing your essential generic medications highly affordable. For Tier 3 preferred brand drugs, standard pharmacy copays are $25 for a 1-month supply, while a 3-month standard mail order costs a $50 copay. Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 35% and 33% coinsurance respectively. Additionally, Tier 6 select care drugs are available with a low $10 copay for a 1-month supply at standard pharmacies.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance. Members pay no copay for primary care physician visits, while specialist visits and physical therapy sessions require a low $3 copay. For hospital care, inpatient stays feature no coinsurance, with a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Routine dental, vision, and hearing services are covered with no copay, which includes annual allowances of $400 for eyewear and up to $1,000 per ear for prescription hearing aids. The plan also supports daily living with no-copay home health services and a generous $110 monthly reimbursement for over-the-counter items.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered, and both referrals and prior authorizations are required.
Outpatient Services See details
Advantage Care by Ultimate (HMO C-SNP) covers outpatient hospital and observation services for a $195 copay and ambulatory surgical center services for a $25 copay, with no coinsurance. Outpatient substance abuse services require a $10 copay for group sessions and a $20 copay for individual sessions with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Advantage Care by Ultimate (HMO C-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Advantage Care by Ultimate (HMO C-SNP) covers ambulance services with a $200 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are partially covered with no copay and no coinsurance for plan-approved locations, but trips to any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Advantage Care by Ultimate (HMO C-SNP) with a $120 copay and no coinsurance, and urgently needed services are covered with a $10 copay and no coinsurance, with both copays waived if admitted within 24 hours. Worldwide emergency services are partially covered up to a $50,000 limit with a $100 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care by Ultimate (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while opioid treatment services have no copay and a 20% coinsurance. Most other covered services, including specialists, physical therapy, and mental health sessions, require a $3 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance. Covered benefits include Medicare-covered preventive care, kidney disease education, and memory fitness, while annual physical exams, in-home safety assessments, PERS, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Advantage Care by Ultimate (HMO C-SNP) provides partially covered hearing services, featuring one routine hearing exam and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $1,000 per ear annually, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Advantage Care by Ultimate (HMO C-SNP), offering one routine eye exam per year with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered eyewear features no coinsurance and a $400 annual limit, with copays applying to Medicare-covered eyewear and upgrades ranging from $30 to $50.
Dental Services See details
Advantage Care by Ultimate (HMO C-SNP) features partially covered dental services with no copay and no coinsurance for covered benefits. Sub-services that are not covered under this plan include other diagnostic, other preventive, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Advantage Care by Ultimate (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs have a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by Advantage Care by Ultimate (HMO C-SNP), offering durable medical equipment, prosthetic devices, and medical supplies with no copay, a 20% coinsurance, and prior authorization requirements. Diabetic equipment features 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 are covered by Advantage Care by Ultimate (HMO C-SNP) with prior authorization and referrals required. Lab services feature no copay and no coinsurance, while diagnostic procedures have no coinsurance and a copay ranging from $0 to $195. Diagnostic radiological services require a minimum $25 copay, therapeutic radiological services require a 20% coinsurance, and outpatient X-rays have no copay but are subject to coinsurance.
Home Health Services See details
Advantage Care by Ultimate (HMO C-SNP) covers home health services 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 Advantage Care by Ultimate (HMO C-SNP) with no coinsurance and require prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan and carry a $5 copay.
Skilled Nursing Facility (SNF) See details
Advantage Care by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 39 through 100, a $150 daily copay for days 21 through 38, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance, featuring a chronic illness meal benefit and a $110 monthly reimbursement for over-the-counter (OTC) items. However, acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved