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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 2025, 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 2025.
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 $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 Advantage Care by Ultimate (HMO C-SNP) plan has an enhanced alternative drug benefit. There is no deductible for this plan. In the initial coverage phase, you will pay no copay for preferred generic drugs and $25 for standard generic drugs. Preferred brand drugs have a $60 copay, non-preferred drugs have 33% coinsurance, and specialty tier drugs have a $10 copay. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers a variety of health benefits with varying costs. The plan covers inpatient hospital stays, with a copay for the first five days, as well as outpatient services, emergency services, and primary care, each with its own copay structure. Preventive, hearing, vision, and dental services are also included, with routine eye exams having no copay and eyewear coverage up to a certain amount. Additional benefits include home health services with no copay, and skilled nursing facility stays with a copay for days 21-38. The plan also provides coverage for ambulance services, home infusion, dialysis, and medical equipment, each with its own cost-sharing arrangement. However, some services like acupuncture, over-the-counter items, and certain types of therapy are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Advantage Care by Ultimate (HMO C-SNP) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, you will pay a copay of $150 for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by Advantage Care by Ultimate (HMO C-SNP), including outpatient hospital services with a $195 copay, observation services with a $195 copay, ambulatory surgical center services with a $25 copay, outpatient substance abuse services with a $20 copay for individual sessions and a $10 copay for 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 by Advantage Care by Ultimate (HMO C-SNP), but requires prior authorization and a doctor referral. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan, 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, while 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 by Advantage Care by Ultimate (HMO C-SNP). Emergency Services have a $75 copay and no coinsurance, Urgently Needed Services have a $10 copay and no coinsurance, and Worldwide Emergency Coverage has a $100 copay and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $15 copay, Mental Health Specialty Services with a $15 copay for individual sessions and a $10 copay for group sessions, and Physical Therapy and Speech-Language Pathology Services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered, and Opioid Treatment Program Services have 20% coinsurance.
Preventive Services See details
Preventive Services are covered by Advantage Care by Ultimate (HMO C-SNP), including Medicare-covered preventive services with prior authorization and referral, plus additional services like Health Education, Medical Nutrition Therapy, 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 Assessments, Personal Emergency Response Systems (PERS), 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
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year, and prescription hearing aids are covered up to $1,000 per year. Prescription hearing aids are not covered for inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers vision services, including routine eye exams with no copay and eyewear with a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, with the eyeglasses and eyeglass lenses and frames limited to one pair per year, and upgrades have a copay of $30-$50.
Dental Services See details
Dental Services include coverage for oral exams with a limit of two visits, dental x-rays with a limit of two per year, prophylaxis (cleaning) with a limit of one every six months, and fluoride treatments with a limit of one every six months; restorative services, endodontics, periodontics and oral and maxillofacial surgery are covered, but require prior authorization; however, prosthodontics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Advantage Care by Ultimate (HMO C-SNP). You will pay 20% coinsurance, and a referral and prior authorization are required.
Medical Equipment See details
Medical Equipment is covered by Advantage Care by Ultimate (HMO C-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and no copay, and Prosthetics/Medical Supplies and Diabetic Equipment, which require prior authorization. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a maximum copay of $195 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 at most $195, with a minimum of $25, 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 Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Advantage Care by Ultimate (HMO C-SNP), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for the covered services, and the copay is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Advantage Care by Ultimate (HMO C-SNP). There is no copay for days 1-20 and days 39-100, but there is a $150 copay for days 21-38; there is no coinsurance for this benefit.
Other Services See details
Other Services are not covered by the Advantage Care by Ultimate (HMO C-SNP) plan. The plan does not cover 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.
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