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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 Manatee and Sarasota 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 $3400.00 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 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. For Tier 6 select care drugs, there is a $10 copay for a one-month standard pharmacy supply and a $20 copay for a three-month standard mail order. Tier 3 preferred brand drugs require a $25 copay for a one-month standard pharmacy supply, while a three-month standard mail order costs $50. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 35% coinsurance for both standard pharmacy and standard mail order. Specialty drugs in Tier 5 carry a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
Advantage Care by Ultimate (HMO C-SNP) offers affordable healthcare coverage with many essential services requiring no copay and no coinsurance. You will pay no copay for primary care doctor visits, preventive care, home health services, and routine dental, hearing, and vision exams. Specialist office visits require a low $3 copay, while inpatient hospital stays feature a $165 daily copay for the first five days and no copay for days 6 through 90. Emergency room visits carry a $120 copay and ground ambulance services require a $200 copay, with no coinsurance for either service. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, the plan features valuable extra benefits, including up to $1,000 per ear annually for hearing aids, a $400 annual eyewear allowance, and a $105 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Advantage Care by Ultimate (HMO C-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, charging a $165 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered under this plan.
Outpatient Services See details
Advantage Care by Ultimate (HMO C-SNP) covers outpatient hospital and observation services with a $195 copay and no coinsurance, and ambulatory surgical center services with a $25 copay and no coinsurance. Outpatient substance abuse services require no coinsurance with 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, although prior authorization and a referral are required.
Ambulance and Transportation Services See details
Advantage Care by Ultimate (HMO C-SNP) covers ambulance and transportation services, though transportation is only partially covered because trips to non-approved health-related locations are excluded. Ground ambulance services require a $200 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and unlimited transportation to plan-approved locations is available with no copay and no coinsurance.
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 you are admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $50,000 lifetime 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) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $3 copay and no coinsurance. Opioid treatment is covered with no copay and a 20% coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance for covered care, though some services require a referral or prior authorization. While Medicare-covered preventive care, glaucoma screenings, and kidney disease education are covered, the plan does not cover annual physical exams, weight management programs, or in-home safety assessments.
Hearing Services See details
Hearing services are covered by Advantage Care by Ultimate (HMO C-SNP) with no copay and no coinsurance, including one routine exam and one fitting evaluation annually. Prescription hearing aids are partially covered up to $1,000 per ear every year with no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Advantage Care by Ultimate (HMO C-SNP) with no deductible, 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 up to a $400 annual limit for contacts or one pair of eyeglasses, with upgrades requiring a $30 to $50 copay.
Dental Services See details
Advantage Care by Ultimate (HMO C-SNP) provides partially covered dental services with no copay and no coinsurance for covered treatments, although some require prior authorization. Sub-services that are not covered include other diagnostic, other preventive, fixed and removable 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 plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under Advantage Care by Ultimate (HMO C-SNP) with no copay and a 20% coinsurance. This benefit requires both a referral and prior authorization.
Medical Equipment See details
Advantage Care by Ultimate (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and diabetic 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 referrals and prior authorization for all services. Lab and diagnostic radiological services feature no copay and no coinsurance, diagnostic tests range from no copay to a $195 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with 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
Cardiac Rehabilitation Services are covered under the Advantage Care by Ultimate (HMO C-SNP) plan with no copay, no coinsurance, and prior authorization required, although only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Advantage Care by Ultimate (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 39 to 100, and a $150 copay for days 21 to 38. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered benefit are not covered.
Other Services See details
Advantage Care by Ultimate (HMO C-SNP) offers partial coverage for other services, which includes chronic illness meal benefits and up to $105 per month for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other additional services under this benefit category are not covered.
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