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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 Manatee and Sarasota 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 $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 has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay the following for your prescriptions: $0 copay for Standard Generic drugs, $25.00 copay for Standard Generic drugs, $70.00 copay for Preferred Brand drugs, 33% coinsurance for Non-Preferred drugs, and $10.00 copay for Specialty Tier drugs. Once your total drug costs reach $2000.00, you will enter the next coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Advantage Care by Ultimate (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with a copay, and ambulance services with varying copays and coinsurance. The plan also provides coverage for primary care, preventive services, hearing, vision, dental, and home health services. This plan includes additional benefits such as coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facility stays. However, it's important to note that some services like certain dental procedures, vision services, and other specialized services may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits with Advantage Care by Ultimate (HMO C-SNP) require prior authorization and a doctor referral, with a copay of $165 for days 1-5 and no copay for days 6-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Advantage Care by Ultimate (HMO C-SNP) with a $195 copay. Ambulatory Surgical Center (ASC) Services have a $25 copay, and Outpatient Substance Abuse Services have a copay of $20 for individual sessions and $10 for group sessions. Outpatient blood services are also covered.
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 provided about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Advantage Care by Ultimate (HMO C-SNP), 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, but 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 has a $75 copay, Urgently Needed Services has a $10 copay, and Worldwide Emergency Coverage has a $100 copay, 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 $10-15 copay), physical therapy and speech-language pathology services (with a $20 copay), additional telehealth benefits, and opioid treatment program services (with a 20% coinsurance). Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and additional preventive services like health education and medical nutrition therapy. However, 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, and support for caregivers of enrollees are not covered. Additional sessions of smoking and tobacco cessation counseling, a fitness benefit (memory fitness), remote access technologies, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following the Welcome Visit are also covered.
Hearing Services See details
Hearing services include coverage for 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 - inner ear, outer ear, and over the ear are not covered, and 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 1 visit every year, and eyewear with a combined maximum benefit of $300 per year, and upgrades with a copay of $30-$50. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. 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 have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Advantage Care by Ultimate (HMO C-SNP) and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. 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 under the Advantage Care by Ultimate (HMO C-SNP) plan. Diagnostic Procedures/Tests have a maximum copay of $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 maximum copay of $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 Advantage Care by Ultimate (HMO C-SNP) with no copay or coinsurance, but authorization and a referral are required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Advantage Care by Ultimate (HMO C-SNP) with prior authorization and a doctor referral required. For days 1-20, there is no copay, for days 21-38, the copay is $150, and for days 39-100, there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Advantage Care by Ultimate (HMO C-SNP) 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. The plan does cover a meal benefit for a chronic illness.
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