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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 Polk county. 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 $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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, but will pay $30 for standard generic drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with a $160 copay for days 1-5 and no copay for days 6-90, and outpatient services with a $195 copay. You will also have access to coverage for emergency services, ambulance services, and various therapies with varying copays and coinsurance amounts. Additionally, this plan provides coverage for hearing, vision, and dental services, with specific allowances for hearing aids and eyewear. There is also coverage for home health services, dialysis services, and medical equipment, with some services requiring prior authorization and copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage with Advantage Care by Ultimate (HMO C-SNP) requires prior authorization and a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you'll pay a $160 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, require a $195 copay, while Ambulatory Surgical Center services have a $25 copay. Individual outpatient substance abuse sessions have a $20 copay, and group sessions have a $10 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Advantage Care by Ultimate (HMO C-SNP) plan, but requires prior authorization and a doctor referral. The plan does not specify any cost for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Advantage Care by Ultimate (HMO C-SNP), including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $150 copay, while air ambulance services have 20% coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Advantage Care by Ultimate (HMO C-SNP) plan. Emergency Services have a $75 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage has a $100 copay. 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, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, and occupational therapy services have a $20 copay. Physician specialist services and individual sessions for mental health and psychiatric services have a $15 copay, while group sessions for mental health and psychiatric services have a $10 copay. Physical therapy and speech-language pathology services have a $20 copay, and opioid treatment program services have 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers preventive services, including Medicare-covered preventive services with no copay and additional preventive services. Some services are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, and counseling services. The plan also covers kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following the Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered, with a maximum benefit of $1,000 per year for all types except inner ear, outer ear, and over-the-ear hearing aids, which are not covered.
Vision Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers vision services, including routine eye exams with one visit per year. Eyewear is covered with a combined maximum of $300 per year, and upgrades have a copay of $30-$50. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered.
Dental Services See details
The Advantage Care by Ultimate (HMO C-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, cleanings, and fluoride treatments. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered, but require prior authorization. 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, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Advantage Care by Ultimate (HMO C-SNP), but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Advantage Care by Ultimate (HMO C-SNP), including Durable Medical Equipment with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment. However, 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 include coverage for diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a copay of up to $195 and a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $195, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Advantage Care by Ultimate (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Advantage Care by Ultimate (HMO C-SNP), with a $0 copay for days 1-20 and days 39-100, and a $150 copay for days 21-38. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, with the exception of a Meal Benefit for a chronic illness. 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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