Premier Plus by Ultimate (HMO) is a Medicare Advantage (Part C) Plan by Ultimate Health Plans.
This page features plan details for 2023 Premier Plus by Ultimate (HMO) H2962 – 032 – 0 available in Cit, Her, Ind, Pas and SLu Counties, FL.
Premier Plus by Ultimate (HMO) is offered in the following locations.
Premier Plus by Ultimate (HMO) offers the following coverage and cost-sharing.
Insurer: | Ultimate Health Plans |
Health Plan Deductible: | $0.00 |
MOOP: | $1,200 In-network |
Drugs Covered: | Yes |
Ready to sign up for Premier Plus by Ultimate (HMO) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$164.90 | $0.00 | $0.00 | $0.00 | $164.90 |
Premier Plus by Ultimate (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $4,660.00 |
Catastrophic Coverage Limit: | $7,400.00 |
Drug Benefit Type: | Enhanced |
Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$0.00 | $43.40 | $34.80 | $26.30 | $17.70 |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Generic) | $0.00 copay | |||
2 (Preferred Brand) | $5.00 copay | |||
3 (Non-Preferred Drug) | $45.00 copay | |||
4 (Specialty Tier) | 33% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Generic) | ||||
2 (Preferred Brand) | ||||
3 (Non-Preferred Drug) | ||||
4 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Generic) | $0.00 copay | $0.00 copay | ||
2 (Preferred Brand) | $15.00 copay | $10.00 copay | ||
3 (Non-Preferred Drug) | $135.00 copay | $90.00 copay | ||
4 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Generic) | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Generic) | $0.00 copay | $0.00 copay |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Drug Type | Cost Share |
---|---|
Generic drugs | $4.15 copay or 5% (whichever costs more) |
Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Premier Plus by Ultimate (HMO) also provides the following benefits.
In-Network: No |
Diagnostic services: | $0 copay (limits may apply) (authorization required) (referral not required) |
Endodontics: | $0 copay (limits may apply) (authorization required) (referral not required) |
Extractions: | $0 copay (limits may apply) (authorization required) (referral not required) |
Non-routine services: | Not covered (no limits) |
Periodontics: | $0 copay (limits may apply) (authorization required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | $0 copay (no limits) (authorization required) (referral not required) |
Restorative services: | $0 copay (limits may apply) (authorization required) (referral not required) |
Cleaning: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | $0 copay (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | $0-100 copay (authorization required) (referral required) |
Diagnostic tests and procedures: | $0-100 copay (authorization required) (referral required) |
Lab services: | $0-100 copay or 0-20% coinsurance (authorization required) (referral required) |
Outpatient x-rays: | $0-100 copay (authorization required) (referral required) |
Primary: | $0 copay |
Specialist: | $0 copay (authorization required) (referral required) |
Emergency: | $50 copay per visit (always covered) |
Urgent care: | $10 copay per visit (always covered) |
Foot exams and treatment: | $0 copay (authorization not required) (referral required) |
Routine foot care: | Not covered |
$150 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing aids: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing exam: | $0 copay (authorization not required) (referral not required) |
$0 copay (authorization required) (referral required) |
$50-100 copay per visit (authorization required) (referral required) |
$1,200 In-network |
Diabetes supplies: | $0 copay (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
Chemotherapy: | 20% coinsurance (authorization required) |
Other Part B drugs: | 20% coinsurance (authorization required) |
Inpatient hospital – psychiatric: | $0 copay (authorization required) (referral required) |
Outpatient group therapy visit: | $0 copay (authorization not required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | $0 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit: | $0 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | $0 copay (authorization not required) (referral not required) |
No |
$0 copay (authorization required) (referral required) |
Occupational therapy visit: | $0 copay (authorization required) (referral required) |
Physical therapy and speech and language therapy visit: | $0 copay (authorization required) (referral required) |
$0 per day for days 1 through 20 $150 per day for days 21 through 31 $0 per day for days 32 through 100 (authorization required) (referral required) |
$0 copay (limits may apply) (authorization not required) (referral not required) |
Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
Other: | Not covered (no limits) |
Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Upgrades: | $30-50 copay (limits may apply) (authorization not required) (referral not required) |
Covered (authorization not required) (referral not required) |
Ready to sign up for Premier Plus by Ultimate (HMO) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services.
HealthCompare Insurance Services does not offer every plan available in your area. Currently, HealthCompare Insurance Services represents 18 organizations, which offer 52,101 products in your area.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.