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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 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 Polk county. 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 $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 Advantage Care by Ultimate (HMO C-SNP) plan features a $0 prescription drug deductible, allowing your coverage to begin immediately. Members pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for both 1-month and 3-month supplies at standard pharmacies. Additionally, there is no copay for a 3-month supply of these generic medications when using standard mail order. For higher-tier medications, Tier 3 preferred brand drugs carry a $30 copay for a 1-month standard pharmacy supply, or a $60 copay for a 3-month standard mail order. Tier 6 select care drugs have a $10 standard pharmacy copay for a 1-month supply, while Tier 4 non-preferred drugs require a 35% coinsurance. Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at a standard pharmacy.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers comprehensive medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits. Members pay a $160 daily copay for days 1 through 5 of inpatient hospital stays, while emergency room visits carry a $120 copay with no coinsurance. Specialist visits, physical therapies, and mental health services are also highly affordable, requiring only a $3 copay and no coinsurance. This plan also includes valuable supplemental benefits such as routine dental, vision, and hearing care with no copays or coinsurance, including up to $1,000 per ear annually for prescription hearing aids. Additionally, members can take advantage of unlimited one-way transportation to plan-approved health locations and a $110 monthly over-the-counter reimbursement with no copay. These extra perks help ensure you can manage your daily health needs easily and affordably without unexpected financial strain.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $160 daily copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. While prior authorization and referrals are required, additional days, non-Medicare-covered stays, and acute upgrades are not covered.
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, all with no coinsurance. Outpatient substance abuse services have no coinsurance and require a $20 copay for individual sessions and a $10 copay for group sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Advantage Care by Ultimate (HMO C-SNP) 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 ground ambulance services with a $200 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Advantage Care by Ultimate (HMO C-SNP) covers emergency services with a $120 copay and urgent care with a $10 copay, with no coinsurance for either service and copays waived if 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
Advantage Care by Ultimate (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require a $3 copay and no coinsurance. Opioid treatment program 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 Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered benefits, though some services may require a referral or prior authorization. While benefits like health education and glaucoma screenings are included, several sub-services are not covered, such as annual physical exams, weight management programs, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Advantage Care by Ultimate (HMO C-SNP), offering no copay and no coinsurance for annual routine hearing exams, fitting evaluations, and prescription hearing aids with a maximum coverage of $1,000 per ear every year. OTC hearing aids, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Advantage Care by Ultimate (HMO C-SNP) provides partially covered vision services, offering one routine eye exam per year with no copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no coinsurance and a $300 annual maximum, though copays apply to upgrades ($30 to $50) and Medicare-covered eyewear benefits.
Dental Services See details
Dental services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered benefits, though prior authorization is required for restorative, endodontic, periodontic, adjunctive, and oral surgery services. Non-covered services under this plan include other diagnostic services, other preventive services, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
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
Advantage Care by Ultimate (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Advantage Care by Ultimate (HMO C-SNP) covers diagnostic and radiological services, requiring both referrals and prior authorization. Lab services feature no copay and no coinsurance, while diagnostic tests carry no coinsurance and a copay ranging from no copay up to $195. Diagnostic radiological services require a copay starting at $25 with no coinsurance, while therapeutic radiology requires a 20% coinsurance and a copay, and outpatient X-rays feature 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, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Advantage Care by Ultimate (HMO C-SNP) covers Cardiac Rehabilitation Services with no coinsurance, but prior authorization is required and only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and carry a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Advantage Care by Ultimate (HMO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and days 39 to 100, and a $150 copay for days 21 to 38. Prior authorization and a referral are required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Advantage Care by Ultimate (HMO C-SNP) offers partial coverage for other services, featuring a chronic illness meal benefit and a $110 monthly over-the-counter reimbursement with no copay and no coinsurance. Acupuncture and Naloxone OTC items are not covered under these benefits.
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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